hospital_name,last_updated_on,version,location_name,hospital_address,license_number|OK,type_2_npi,"To the best of its knowledge and belief, this 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 in the file. This hospital has included all payer-specific negotiated charges in dollars that can be expressed as a dollar amount. For payer-specific negotiated charges that cannot be expressed as a dollar amount in the machine-readable file or not knowable in advance, the hospital attests that the payer-specific negotiated charge is based on a contractual algorithm, percentage or formula that precludes the provision of a dollar amount and has provided all necessary information available to the hospital for the public to be able to derive the dollar amount, including, but not limited to, the specific fee schedule or components referenced in such percentage, algorithm or formula.",attester_name,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
OU Health - University of Oklahoma Medical Center,7/29/2026,3.0.0,OU Health|OU Health - University of Oklahoma Medical Center|Oklahoma Childrens Hospital OU Health|OU Health Edmond Medical Center,"700 NE 13th St,Oklahoma City,OK,73104|1200 Childrens Ave, Oklahoma City, OK 73104|One South Bryant Ave, Edmond, OK 73034",02301,1649794157 | 1609390111,TRUE,Krystal Murer,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
description,code|1,code|1|type,code|2,code|2|type,code|3,code|3|type,modifiers,setting,drug_unit_of_measurement,drug_type_of_measurement,standard_charge|gross,standard_charge|discounted_cash,standard_charge|Aetna Better Health|Managed Medicaid|negotiated_dollar,standard_charge|Aetna Better Health|Managed Medicaid|negotiated_percentage,standard_charge|Aetna Better Health|Managed Medicaid|negotiated_algorithm,median_amount|Aetna Better Health|Managed Medicaid,10th_percentile|Aetna Better Health|Managed Medicaid,90th_percentile|Aetna Better Health|Managed Medicaid,count|Aetna Better Health|Managed Medicaid,standard_charge|Aetna Better Health|Managed Medicaid|methodology,additional_payer_notes|Aetna Better Health|Managed Medicaid,standard_charge|Aetna Health|HMO|negotiated_dollar,standard_charge|Aetna Health|HMO|negotiated_percentage,standard_charge|Aetna Health|HMO|negotiated_algorithm,median_amount|Aetna Health|HMO,10th_percentile|Aetna Health|HMO,90th_percentile|Aetna Health|HMO,count|Aetna Health|HMO,standard_charge|Aetna Health|HMO|methodology,additional_payer_notes|Aetna Health|HMO,standard_charge|Aetna Health|Managed Choice Pos and Elect Choice|negotiated_dollar,standard_charge|Aetna Health|Managed Choice Pos and Elect Choice|negotiated_percentage,standard_charge|Aetna Health|Managed Choice Pos and Elect Choice|negotiated_algorithm,median_amount|Aetna Health|Managed Choice Pos and Elect Choice,10th_percentile|Aetna Health|Managed Choice Pos and Elect Choice,90th_percentile|Aetna Health|Managed Choice Pos and Elect Choice,count|Aetna Health|Managed Choice Pos and Elect Choice,standard_charge|Aetna Health|Managed Choice Pos and Elect Choice|methodology,additional_payer_notes|Aetna Health|Managed Choice Pos and Elect Choice,standard_charge|Aetna Health|National Advantage Program|negotiated_dollar,standard_charge|Aetna Health|National Advantage Program|negotiated_percentage,standard_charge|Aetna Health|National Advantage Program|negotiated_algorithm,median_amount|Aetna Health|National Advantage Program,10th_percentile|Aetna Health|National Advantage Program,90th_percentile|Aetna Health|National Advantage Program,count|Aetna Health|National Advantage Program,standard_charge|Aetna Health|National Advantage Program|methodology,additional_payer_notes|Aetna Health|National Advantage Program,standard_charge|Aetna Health|Open Choice PPO|negotiated_dollar,standard_charge|Aetna Health|Open Choice PPO|negotiated_percentage,standard_charge|Aetna Health|Open Choice PPO|negotiated_algorithm,median_amount|Aetna Health|Open Choice PPO,10th_percentile|Aetna Health|Open Choice PPO,90th_percentile|Aetna Health|Open Choice PPO,count|Aetna Health|Open Choice PPO,standard_charge|Aetna Health|Open Choice PPO|methodology,additional_payer_notes|Aetna Health|Open Choice PPO,standard_charge|Aetna Health|Transplant Services|negotiated_dollar,standard_charge|Aetna Health|Transplant Services|negotiated_percentage,standard_charge|Aetna Health|Transplant Services|negotiated_algorithm,median_amount|Aetna Health|Transplant Services,10th_percentile|Aetna Health|Transplant Services,90th_percentile|Aetna Health|Transplant Services,count|Aetna Health|Transplant Services,standard_charge|Aetna Health|Transplant Services|methodology,additional_payer_notes|Aetna Health|Transplant Services,standard_charge|Aetna Health/Coventry|Commercial|negotiated_dollar,standard_charge|Aetna Health/Coventry|Commercial|negotiated_percentage,standard_charge|Aetna Health/Coventry|Commercial|negotiated_algorithm,median_amount|Aetna Health/Coventry|Commercial,10th_percentile|Aetna Health/Coventry|Commercial,90th_percentile|Aetna Health/Coventry|Commercial,count|Aetna Health/Coventry|Commercial,standard_charge|Aetna Health/Coventry|Commercial|methodology,additional_payer_notes|Aetna Health/Coventry|Commercial,standard_charge|Aetna Health/First Health|Commercial|negotiated_dollar,standard_charge|Aetna Health/First Health|Commercial|negotiated_percentage,standard_charge|Aetna Health/First Health|Commercial|negotiated_algorithm,median_amount|Aetna Health/First Health|Commercial,10th_percentile|Aetna Health/First Health|Commercial,90th_percentile|Aetna Health/First Health|Commercial,count|Aetna Health/First Health|Commercial,standard_charge|Aetna Health/First Health|Commercial|methodology,additional_payer_notes|Aetna Health/First Health|Commercial,standard_charge|Ameri-Plus Preferred Care Inc|Medicare Advantage|negotiated_dollar,standard_charge|Ameri-Plus Preferred Care Inc|Medicare Advantage|negotiated_percentage,standard_charge|Ameri-Plus Preferred Care Inc|Medicare Advantage|negotiated_algorithm,median_amount|Ameri-Plus Preferred Care Inc|Medicare Advantage,10th_percentile|Ameri-Plus Preferred Care Inc|Medicare Advantage,90th_percentile|Ameri-Plus Preferred Care Inc|Medicare Advantage,count|Ameri-Plus Preferred Care Inc|Medicare Advantage,standard_charge|Ameri-Plus Preferred Care Inc|Medicare Advantage|methodology,additional_payer_notes|Ameri-Plus Preferred Care Inc|Medicare Advantage,standard_charge|Blue Cross Blue Shield of OK|Blue Advantage PPO|negotiated_dollar,standard_charge|Blue Cross Blue Shield of OK|Blue Advantage PPO|negotiated_percentage,standard_charge|Blue Cross Blue Shield of OK|Blue Advantage PPO|negotiated_algorithm,median_amount|Blue Cross Blue Shield of OK|Blue Advantage PPO,10th_percentile|Blue Cross Blue Shield of OK|Blue Advantage PPO,90th_percentile|Blue Cross Blue Shield of OK|Blue Advantage PPO,count|Blue Cross Blue Shield of OK|Blue Advantage PPO,standard_charge|Blue Cross Blue Shield of OK|Blue Advantage PPO|methodology,additional_payer_notes|Blue Cross Blue Shield of OK|Blue Advantage PPO,standard_charge|Blue Cross Blue Shield of OK|Blue Choice PPO|negotiated_dollar,standard_charge|Blue Cross Blue Shield of OK|Blue Choice PPO|negotiated_percentage,standard_charge|Blue Cross Blue Shield of OK|Blue Choice PPO|negotiated_algorithm,median_amount|Blue Cross Blue Shield of OK|Blue Choice PPO,10th_percentile|Blue Cross Blue Shield of OK|Blue Choice PPO,90th_percentile|Blue Cross Blue Shield of OK|Blue Choice PPO,count|Blue Cross Blue Shield of OK|Blue Choice PPO,standard_charge|Blue Cross Blue Shield of OK|Blue Choice PPO|methodology,additional_payer_notes|Blue Cross Blue Shield of OK|Blue Choice PPO,standard_charge|Blue Cross Blue Shield of OK|Blue Plan65 Select|negotiated_dollar,standard_charge|Blue Cross Blue Shield of OK|Blue Plan65 Select|negotiated_percentage,standard_charge|Blue Cross Blue Shield of OK|Blue Plan65 Select|negotiated_algorithm,median_amount|Blue Cross Blue Shield of OK|Blue Plan65 Select,10th_percentile|Blue Cross Blue Shield of OK|Blue Plan65 Select,90th_percentile|Blue Cross Blue Shield of OK|Blue Plan65 Select,count|Blue Cross Blue Shield of OK|Blue Plan65 Select,standard_charge|Blue Cross Blue Shield of OK|Blue Plan65 Select|methodology,additional_payer_notes|Blue Cross Blue Shield of OK|Blue Plan65 Select,standard_charge|Blue Cross Blue Shield of OK|Blue Preferred PPO|negotiated_dollar,standard_charge|Blue Cross Blue Shield of OK|Blue Preferred PPO|negotiated_percentage,standard_charge|Blue Cross Blue Shield of OK|Blue Preferred PPO|negotiated_algorithm,median_amount|Blue Cross Blue Shield of OK|Blue Preferred PPO,10th_percentile|Blue Cross Blue Shield of OK|Blue Preferred PPO,90th_percentile|Blue Cross Blue Shield of OK|Blue Preferred PPO,count|Blue Cross Blue Shield of OK|Blue Preferred PPO,standard_charge|Blue Cross Blue Shield of OK|Blue Preferred PPO|methodology,additional_payer_notes|Blue Cross Blue Shield of OK|Blue Preferred PPO,standard_charge|Blue Cross Blue Shield of OK|BlueLincs HMO|negotiated_dollar,standard_charge|Blue Cross Blue Shield of OK|BlueLincs HMO|negotiated_percentage,standard_charge|Blue Cross Blue Shield of OK|BlueLincs HMO|negotiated_algorithm,median_amount|Blue Cross Blue Shield of OK|BlueLincs HMO,10th_percentile|Blue Cross Blue Shield of OK|BlueLincs HMO,90th_percentile|Blue Cross Blue Shield of OK|BlueLincs HMO,count|Blue Cross Blue Shield of OK|BlueLincs HMO,standard_charge|Blue Cross Blue Shield of OK|BlueLincs HMO|methodology,additional_payer_notes|Blue Cross Blue Shield of OK|BlueLincs HMO,standard_charge|Blue Cross Blue Shield of OK|BlueLincs HMO Emp.|negotiated_dollar,standard_charge|Blue Cross Blue Shield of OK|BlueLincs HMO Emp.|negotiated_percentage,standard_charge|Blue Cross Blue Shield of OK|BlueLincs HMO Emp.|negotiated_algorithm,median_amount|Blue Cross Blue Shield of OK|BlueLincs HMO Emp.,10th_percentile|Blue Cross Blue Shield of OK|BlueLincs HMO Emp.,90th_percentile|Blue Cross Blue Shield of OK|BlueLincs HMO Emp.,count|Blue Cross Blue Shield of OK|BlueLincs HMO Emp.,standard_charge|Blue Cross Blue Shield of OK|BlueLincs HMO Emp.|methodology,additional_payer_notes|Blue Cross Blue Shield of OK|BlueLincs HMO Emp.,standard_charge|Blue Cross Blue Shield of OK|BlueTraditional|negotiated_dollar,standard_charge|Blue Cross Blue Shield of OK|BlueTraditional|negotiated_percentage,standard_charge|Blue Cross Blue Shield of OK|BlueTraditional|negotiated_algorithm,median_amount|Blue Cross Blue Shield of OK|BlueTraditional,10th_percentile|Blue Cross Blue Shield of OK|BlueTraditional,90th_percentile|Blue Cross Blue Shield of OK|BlueTraditional,count|Blue Cross Blue Shield of OK|BlueTraditional,standard_charge|Blue Cross Blue Shield of OK|BlueTraditional|methodology,additional_payer_notes|Blue Cross Blue Shield of OK|BlueTraditional,standard_charge|Blue Cross Blue Shield of OK|NativeBlue|negotiated_dollar,standard_charge|Blue Cross Blue Shield of OK|NativeBlue|negotiated_percentage,standard_charge|Blue Cross Blue Shield of OK|NativeBlue|negotiated_algorithm,median_amount|Blue Cross Blue Shield of OK|NativeBlue,10th_percentile|Blue Cross Blue Shield of OK|NativeBlue,90th_percentile|Blue Cross Blue Shield of OK|NativeBlue,count|Blue Cross Blue Shield of OK|NativeBlue,standard_charge|Blue Cross Blue Shield of OK|NativeBlue|methodology,additional_payer_notes|Blue Cross Blue Shield of OK|NativeBlue,standard_charge|Cigna Health|Gatekeeper Open Access|negotiated_dollar,standard_charge|Cigna Health|Gatekeeper Open Access|negotiated_percentage,standard_charge|Cigna Health|Gatekeeper Open Access|negotiated_algorithm,median_amount|Cigna Health|Gatekeeper Open Access,10th_percentile|Cigna Health|Gatekeeper Open Access,90th_percentile|Cigna Health|Gatekeeper Open Access,count|Cigna Health|Gatekeeper Open Access,standard_charge|Cigna Health|Gatekeeper Open Access|methodology,additional_payer_notes|Cigna Health|Gatekeeper Open Access,standard_charge|Cigna Health|PPO|negotiated_dollar,standard_charge|Cigna Health|PPO|negotiated_percentage,standard_charge|Cigna Health|PPO|negotiated_algorithm,median_amount|Cigna Health|PPO,10th_percentile|Cigna Health|PPO,90th_percentile|Cigna Health|PPO,count|Cigna Health|PPO,standard_charge|Cigna Health|PPO|methodology,additional_payer_notes|Cigna Health|PPO,standard_charge|Cigna Health|PPO Payor Solutions/Strategic Allia|negotiated_dollar,standard_charge|Cigna Health|PPO Payor Solutions/Strategic Allia|negotiated_percentage,standard_charge|Cigna Health|PPO Payor Solutions/Strategic Allia|negotiated_algorithm,median_amount|Cigna Health|PPO Payor Solutions/Strategic Allia,10th_percentile|Cigna Health|PPO Payor Solutions/Strategic Allia,90th_percentile|Cigna Health|PPO Payor Solutions/Strategic Allia,count|Cigna Health|PPO Payor Solutions/Strategic Allia,standard_charge|Cigna Health|PPO Payor Solutions/Strategic Allia|methodology,additional_payer_notes|Cigna Health|PPO Payor Solutions/Strategic Allia,standard_charge|Cigna Health - C|20 New Business Network|negotiated_dollar,standard_charge|Cigna Health - C|20 New Business Network|negotiated_percentage,standard_charge|Cigna Health - C|20 New Business Network|negotiated_algorithm,median_amount|Cigna Health - C|20 New Business Network,10th_percentile|Cigna Health - C|20 New Business Network,90th_percentile|Cigna Health - C|20 New Business Network,count|Cigna Health - C|20 New Business Network,standard_charge|Cigna Health - C|20 New Business Network|methodology,additional_payer_notes|Cigna Health - C|20 New Business Network,standard_charge|Cigna Lifesource|Commercial|negotiated_dollar,standard_charge|Cigna Lifesource|Commercial|negotiated_percentage,standard_charge|Cigna Lifesource|Commercial|negotiated_algorithm,median_amount|Cigna Lifesource|Commercial,10th_percentile|Cigna Lifesource|Commercial,90th_percentile|Cigna Lifesource|Commercial,count|Cigna Lifesource|Commercial,standard_charge|Cigna Lifesource|Commercial|methodology,additional_payer_notes|Cigna Lifesource|Commercial,standard_charge|CommunityCare|CommunityCare Plus|negotiated_dollar,standard_charge|CommunityCare|CommunityCare Plus|negotiated_percentage,standard_charge|CommunityCare|CommunityCare Plus|negotiated_algorithm,median_amount|CommunityCare|CommunityCare Plus,10th_percentile|CommunityCare|CommunityCare Plus,90th_percentile|CommunityCare|CommunityCare Plus,count|CommunityCare|CommunityCare Plus,standard_charge|CommunityCare|CommunityCare Plus|methodology,additional_payer_notes|CommunityCare|CommunityCare Plus,standard_charge|CommunityCare|Medicare Advantage|negotiated_dollar,standard_charge|CommunityCare|Medicare Advantage|negotiated_percentage,standard_charge|CommunityCare|Medicare Advantage|negotiated_algorithm,median_amount|CommunityCare|Medicare Advantage,10th_percentile|CommunityCare|Medicare Advantage,90th_percentile|CommunityCare|Medicare Advantage,count|CommunityCare|Medicare Advantage,standard_charge|CommunityCare|Medicare Advantage|methodology,additional_payer_notes|CommunityCare|Medicare Advantage,standard_charge|CommunityCare|PPO Standard|negotiated_dollar,standard_charge|CommunityCare|PPO Standard|negotiated_percentage,standard_charge|CommunityCare|PPO Standard|negotiated_algorithm,median_amount|CommunityCare|PPO Standard,10th_percentile|CommunityCare|PPO Standard,90th_percentile|CommunityCare|PPO Standard,count|CommunityCare|PPO Standard,standard_charge|CommunityCare|PPO Standard|methodology,additional_payer_notes|CommunityCare|PPO Standard,standard_charge|CommunityCare -HMO|POS Select and Plus|negotiated_dollar,standard_charge|CommunityCare -HMO|POS Select and Plus|negotiated_percentage,standard_charge|CommunityCare -HMO|POS Select and Plus|negotiated_algorithm,median_amount|CommunityCare -HMO|POS Select and Plus,10th_percentile|CommunityCare -HMO|POS Select and Plus,90th_percentile|CommunityCare -HMO|POS Select and Plus,count|CommunityCare -HMO|POS Select and Plus,standard_charge|CommunityCare -HMO|POS Select and Plus|methodology,additional_payer_notes|CommunityCare -HMO|POS Select and Plus,standard_charge|Devoted|Medicare Advantage|negotiated_dollar,standard_charge|Devoted|Medicare Advantage|negotiated_percentage,standard_charge|Devoted|Medicare Advantage|negotiated_algorithm,median_amount|Devoted|Medicare Advantage,10th_percentile|Devoted|Medicare Advantage,90th_percentile|Devoted|Medicare Advantage,count|Devoted|Medicare Advantage,standard_charge|Devoted|Medicare Advantage|methodology,additional_payer_notes|Devoted|Medicare Advantage,standard_charge|Healthcare Highways - Commercial - D|2|negotiated_dollar,standard_charge|Healthcare Highways - Commercial - D|2|negotiated_percentage,standard_charge|Healthcare Highways - Commercial - D|2|negotiated_algorithm,median_amount|Healthcare Highways - Commercial - D|2,10th_percentile|Healthcare Highways - Commercial - D|2,90th_percentile|Healthcare Highways - Commercial - D|2,count|Healthcare Highways - Commercial - D|2,standard_charge|Healthcare Highways - Commercial - D|2|methodology,additional_payer_notes|Healthcare Highways - Commercial - D|2,standard_charge|Healthcare Highways - Commercial - D|3.1|negotiated_dollar,standard_charge|Healthcare Highways - Commercial - D|3.1|negotiated_percentage,standard_charge|Healthcare Highways - Commercial - D|3.1|negotiated_algorithm,median_amount|Healthcare Highways - Commercial - D|3.1,10th_percentile|Healthcare Highways - Commercial - D|3.1,90th_percentile|Healthcare Highways - Commercial - D|3.1,count|Healthcare Highways - Commercial - D|3.1,standard_charge|Healthcare Highways - Commercial - D|3.1|methodology,additional_payer_notes|Healthcare Highways - Commercial - D|3.1,standard_charge|Healthcare Highways - Commercial - D|5|negotiated_dollar,standard_charge|Healthcare Highways - Commercial - D|5|negotiated_percentage,standard_charge|Healthcare Highways - Commercial - D|5|negotiated_algorithm,median_amount|Healthcare Highways - Commercial - D|5,10th_percentile|Healthcare Highways - Commercial - D|5,90th_percentile|Healthcare Highways - Commercial - D|5,count|Healthcare Highways - Commercial - D|5,standard_charge|Healthcare Highways - Commercial - D|5|methodology,additional_payer_notes|Healthcare Highways - Commercial - D|5,standard_charge|Healthcare Highways - Commercial - D|6|negotiated_dollar,standard_charge|Healthcare Highways - Commercial - D|6|negotiated_percentage,standard_charge|Healthcare Highways - Commercial - D|6|negotiated_algorithm,median_amount|Healthcare Highways - Commercial - D|6,10th_percentile|Healthcare Highways - Commercial - D|6,90th_percentile|Healthcare Highways - Commercial - D|6,count|Healthcare Highways - Commercial - D|6,standard_charge|Healthcare Highways - Commercial - D|6|methodology,additional_payer_notes|Healthcare Highways - Commercial - D|6,standard_charge|Healthcare Highways - Commercial -D|1|negotiated_dollar,standard_charge|Healthcare Highways - Commercial -D|1|negotiated_percentage,standard_charge|Healthcare Highways - Commercial -D|1|negotiated_algorithm,median_amount|Healthcare Highways - Commercial -D|1,10th_percentile|Healthcare Highways - Commercial -D|1,90th_percentile|Healthcare Highways - Commercial -D|1,count|Healthcare Highways - Commercial -D|1,standard_charge|Healthcare Highways - Commercial -D|1|methodology,additional_payer_notes|Healthcare Highways - Commercial -D|1,standard_charge|Healthcare Highways - Commercial -D|4|negotiated_dollar,standard_charge|Healthcare Highways - Commercial -D|4|negotiated_percentage,standard_charge|Healthcare Highways - Commercial -D|4|negotiated_algorithm,median_amount|Healthcare Highways - Commercial -D|4,10th_percentile|Healthcare Highways - Commercial -D|4,90th_percentile|Healthcare Highways - Commercial -D|4,count|Healthcare Highways - Commercial -D|4,standard_charge|Healthcare Highways - Commercial -D|4|methodology,additional_payer_notes|Healthcare Highways - Commercial -D|4,standard_charge|HealthChoice|Commercial|negotiated_dollar,standard_charge|HealthChoice|Commercial|negotiated_percentage,standard_charge|HealthChoice|Commercial|negotiated_algorithm,median_amount|HealthChoice|Commercial,10th_percentile|HealthChoice|Commercial,90th_percentile|HealthChoice|Commercial,count|HealthChoice|Commercial,standard_charge|HealthChoice|Commercial|methodology,additional_payer_notes|HealthChoice|Commercial,standard_charge|HealthSmart Preferred Care|ACCEL|negotiated_dollar,standard_charge|HealthSmart Preferred Care|ACCEL|negotiated_percentage,standard_charge|HealthSmart Preferred Care|ACCEL|negotiated_algorithm,median_amount|HealthSmart Preferred Care|ACCEL,10th_percentile|HealthSmart Preferred Care|ACCEL,90th_percentile|HealthSmart Preferred Care|ACCEL,count|HealthSmart Preferred Care|ACCEL,standard_charge|HealthSmart Preferred Care|ACCEL|methodology,additional_payer_notes|HealthSmart Preferred Care|ACCEL,standard_charge|HealthSmart Preferred Care|PPO|negotiated_dollar,standard_charge|HealthSmart Preferred Care|PPO|negotiated_percentage,standard_charge|HealthSmart Preferred Care|PPO|negotiated_algorithm,median_amount|HealthSmart Preferred Care|PPO,10th_percentile|HealthSmart Preferred Care|PPO,90th_percentile|HealthSmart Preferred Care|PPO,count|HealthSmart Preferred Care|PPO,standard_charge|HealthSmart Preferred Care|PPO|methodology,additional_payer_notes|HealthSmart Preferred Care|PPO,standard_charge|Humana|Healthy Horizons Medicaid|negotiated_dollar,standard_charge|Humana|Healthy Horizons Medicaid|negotiated_percentage,standard_charge|Humana|Healthy Horizons Medicaid|negotiated_algorithm,median_amount|Humana|Healthy Horizons Medicaid,10th_percentile|Humana|Healthy Horizons Medicaid,90th_percentile|Humana|Healthy Horizons Medicaid,count|Humana|Healthy Horizons Medicaid,standard_charge|Humana|Healthy Horizons Medicaid|methodology,additional_payer_notes|Humana|Healthy Horizons Medicaid,standard_charge|Humana|Healthy Horizons Medicaid Transplant Agre|negotiated_dollar,standard_charge|Humana|Healthy Horizons Medicaid Transplant Agre|negotiated_percentage,standard_charge|Humana|Healthy Horizons Medicaid Transplant Agre|negotiated_algorithm,median_amount|Humana|Healthy Horizons Medicaid Transplant Agre,10th_percentile|Humana|Healthy Horizons Medicaid Transplant Agre,90th_percentile|Humana|Healthy Horizons Medicaid Transplant Agre,count|Humana|Healthy Horizons Medicaid Transplant Agre,standard_charge|Humana|Healthy Horizons Medicaid Transplant Agre|methodology,additional_payer_notes|Humana|Healthy Horizons Medicaid Transplant Agre,standard_charge|Humana|Medicare Advantage|negotiated_dollar,standard_charge|Humana|Medicare Advantage|negotiated_percentage,standard_charge|Humana|Medicare Advantage|negotiated_algorithm,median_amount|Humana|Medicare Advantage,10th_percentile|Humana|Medicare Advantage,90th_percentile|Humana|Medicare Advantage,count|Humana|Medicare Advantage,standard_charge|Humana|Medicare Advantage|methodology,additional_payer_notes|Humana|Medicare Advantage,standard_charge|Humana|Transplant Agreement|negotiated_dollar,standard_charge|Humana|Transplant Agreement|negotiated_percentage,standard_charge|Humana|Transplant Agreement|negotiated_algorithm,median_amount|Humana|Transplant Agreement,10th_percentile|Humana|Transplant Agreement,90th_percentile|Humana|Transplant Agreement,count|Humana|Transplant Agreement,standard_charge|Humana|Transplant Agreement|methodology,additional_payer_notes|Humana|Transplant Agreement,standard_charge|Oklahoma Complete Care|Managed Medicaid|negotiated_dollar,standard_charge|Oklahoma Complete Care|Managed Medicaid|negotiated_percentage,standard_charge|Oklahoma Complete Care|Managed Medicaid|negotiated_algorithm,median_amount|Oklahoma Complete Care|Managed Medicaid,10th_percentile|Oklahoma Complete Care|Managed Medicaid,90th_percentile|Oklahoma Complete Care|Managed Medicaid,count|Oklahoma Complete Care|Managed Medicaid,standard_charge|Oklahoma Complete Care|Managed Medicaid|methodology,additional_payer_notes|Oklahoma Complete Care|Managed Medicaid,standard_charge|Oklahoma Complete Care|Medicare Advantage|negotiated_dollar,standard_charge|Oklahoma Complete Care|Medicare Advantage|negotiated_percentage,standard_charge|Oklahoma Complete Care|Medicare Advantage|negotiated_algorithm,median_amount|Oklahoma Complete Care|Medicare Advantage,10th_percentile|Oklahoma Complete Care|Medicare Advantage,90th_percentile|Oklahoma Complete Care|Medicare Advantage,count|Oklahoma Complete Care|Medicare Advantage,standard_charge|Oklahoma Complete Care|Medicare Advantage|methodology,additional_payer_notes|Oklahoma Complete Care|Medicare Advantage,standard_charge|OptumHealth Care Solutions|Transplant|negotiated_dollar,standard_charge|OptumHealth Care Solutions|Transplant|negotiated_percentage,standard_charge|OptumHealth Care Solutions|Transplant|negotiated_algorithm,median_amount|OptumHealth Care Solutions|Transplant,10th_percentile|OptumHealth Care Solutions|Transplant,90th_percentile|OptumHealth Care Solutions|Transplant,count|OptumHealth Care Solutions|Transplant,standard_charge|OptumHealth Care Solutions|Transplant|methodology,additional_payer_notes|OptumHealth Care Solutions|Transplant,standard_charge|OptumHealth Care Solutions|VA Transplants|negotiated_dollar,standard_charge|OptumHealth Care Solutions|VA Transplants|negotiated_percentage,standard_charge|OptumHealth Care Solutions|VA Transplants|negotiated_algorithm,median_amount|OptumHealth Care Solutions|VA Transplants,10th_percentile|OptumHealth Care Solutions|VA Transplants,90th_percentile|OptumHealth Care Solutions|VA Transplants,count|OptumHealth Care Solutions|VA Transplants,standard_charge|OptumHealth Care Solutions|VA Transplants|methodology,additional_payer_notes|OptumHealth Care Solutions|VA Transplants,standard_charge|Preferred CommunityChoice|PPO|negotiated_dollar,standard_charge|Preferred CommunityChoice|PPO|negotiated_percentage,standard_charge|Preferred CommunityChoice|PPO|negotiated_algorithm,median_amount|Preferred CommunityChoice|PPO,10th_percentile|Preferred CommunityChoice|PPO,90th_percentile|Preferred CommunityChoice|PPO,count|Preferred CommunityChoice|PPO,standard_charge|Preferred CommunityChoice|PPO|methodology,additional_payer_notes|Preferred CommunityChoice|PPO,standard_charge|QuikTrip|Commercial|negotiated_dollar,standard_charge|QuikTrip|Commercial|negotiated_percentage,standard_charge|QuikTrip|Commercial|negotiated_algorithm,median_amount|QuikTrip|Commercial,10th_percentile|QuikTrip|Commercial,90th_percentile|QuikTrip|Commercial,count|QuikTrip|Commercial,standard_charge|QuikTrip|Commercial|methodology,additional_payer_notes|QuikTrip|Commercial,standard_charge|United Behavioral Health|Commercial|negotiated_dollar,standard_charge|United Behavioral Health|Commercial|negotiated_percentage,standard_charge|United Behavioral Health|Commercial|negotiated_algorithm,median_amount|United Behavioral Health|Commercial,10th_percentile|United Behavioral Health|Commercial,90th_percentile|United Behavioral Health|Commercial,count|United Behavioral Health|Commercial,standard_charge|United Behavioral Health|Commercial|methodology,additional_payer_notes|United Behavioral Health|Commercial,standard_charge|United Behavioral Health|Medicare Advantage|negotiated_dollar,standard_charge|United Behavioral Health|Medicare Advantage|negotiated_percentage,standard_charge|United Behavioral Health|Medicare Advantage|negotiated_algorithm,median_amount|United Behavioral Health|Medicare Advantage,10th_percentile|United Behavioral Health|Medicare Advantage,90th_percentile|United Behavioral Health|Medicare Advantage,count|United Behavioral Health|Medicare Advantage,standard_charge|United Behavioral Health|Medicare Advantage|methodology,additional_payer_notes|United Behavioral Health|Medicare Advantage,standard_charge|United Healthcare|All Payer Appendix|negotiated_dollar,standard_charge|United Healthcare|All Payer Appendix|negotiated_percentage,standard_charge|United Healthcare|All Payer Appendix|negotiated_algorithm,median_amount|United Healthcare|All Payer Appendix,10th_percentile|United Healthcare|All Payer Appendix,90th_percentile|United Healthcare|All Payer Appendix,count|United Healthcare|All Payer Appendix,standard_charge|United Healthcare|All Payer Appendix|methodology,additional_payer_notes|United Healthcare|All Payer Appendix,standard_charge|United Healthcare|Medicare Advantage|negotiated_dollar,standard_charge|United Healthcare|Medicare Advantage|negotiated_percentage,standard_charge|United Healthcare|Medicare Advantage|negotiated_algorithm,median_amount|United Healthcare|Medicare Advantage,10th_percentile|United Healthcare|Medicare Advantage,90th_percentile|United Healthcare|Medicare Advantage,count|United Healthcare|Medicare Advantage,standard_charge|United Healthcare|Medicare Advantage|methodology,additional_payer_notes|United Healthcare|Medicare Advantage,standard_charge|min,standard_charge|max,additional_generic_notes,billing_class
PRINCIPAL DIAGNOSIS INVALID AS DISCHARGE DIAGNOSIS,998,MS-DRG,120,RC,,,,inpatient,,,,,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Stoploss First Dollar + Reimbursement Rate 64.00 + Basic Per Diem + Fixed Rate 2234.00 + Fixed Amount 106065.00,,,,0,other,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,Stoploss First Dollar + Reimbursement Rate 64.00 + Basic Per Diem + Fixed Rate 5518.00 + Fixed Amount 106065.00,,,,0,other,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Short Stay Lesser of + Days Threshold 1.00 + Stoploss First Dollar + Reimbursement Rate 57.00 + Basic Per Diem + Fixed Rate 5000.00 + Fixed Amount 157464.00,,,,0,other,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,Short Stay Lesser of + Days Threshold 1.00 + Stoploss First Dollar + Reimbursement Rate 72.00 + Basic Per Diem + Fixed Rate 10000.00 + Fixed Amount 56687.00,,,,0,other,NTE Percentage + Reimbursement Rate 85.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,Principal Diagnosis Invalid as Discharge Diagnosis,,,,0,other,Principal Diagnosis Invalid as Discharge Diagnosis + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Principal Diagnosis Invalid as Discharge Diagnosis,,,,0,other,Principal Diagnosis Invalid as Discharge Diagnosis + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Principal Diagnosis Invalid as Discharge Diagnosis,,,,0,other,Principal Diagnosis Invalid as Discharge Diagnosis + No services performed during 15-month lookback period,,,Stoploss First Dollar + Reimbursement Rate 52.80 + Basic Per Diem + Fixed Rate 1292.00 + Fixed Amount 56100.00,,,,0,other,Stoploss First Dollar + Reimbursement Rate 52.80 + Basic Per Diem + Fixed Rate 1292.00 + Fixed Amount 56100.00 + No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Principal Diagnosis Invalid as Discharge Diagnosis,,,,0,other,Principal Diagnosis Invalid as Discharge Diagnosis + No services performed during 15-month lookback period,,,Principal Diagnosis Invalid as Discharge Diagnosis,,,,0,other,Principal Diagnosis Invalid as Discharge Diagnosis + No services performed during 15-month lookback period,,47.3,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Principal Diagnosis Invalid as Discharge Diagnosis,,,,0,other,Principal Diagnosis Invalid as Discharge Diagnosis + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Principal Diagnosis Invalid as Discharge Diagnosis,,,,0,other,Principal Diagnosis Invalid as Discharge Diagnosis + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Principal Diagnosis Invalid as Discharge Diagnosis,,,,0,other,Principal Diagnosis Invalid as Discharge Diagnosis + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Principal Diagnosis Invalid as Discharge Diagnosis,,,,0,other,Principal Diagnosis Invalid as Discharge Diagnosis + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6084,,,,,,,per diem,,,,Principal Diagnosis Invalid as Discharge Diagnosis,,,,0,other,Principal Diagnosis Invalid as Discharge Diagnosis + No services performed during 15-month lookback period,6084,6084,,facility
UNGROUPABLE,999,MS-DRG,120,RC,,,,inpatient,,,,,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Stoploss First Dollar + Reimbursement Rate 64.00 + Basic Per Diem + Fixed Rate 2234.00 + Fixed Amount 106065.00,,,,0,other,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,Stoploss First Dollar + Reimbursement Rate 64.00 + Basic Per Diem + Fixed Rate 5518.00 + Fixed Amount 106065.00,,,,0,other,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Short Stay Lesser of + Days Threshold 1.00 + Stoploss First Dollar + Reimbursement Rate 57.00 + Basic Per Diem + Fixed Rate 5000.00 + Fixed Amount 157464.00,,,,0,other,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,Short Stay Lesser of + Days Threshold 1.00 + Stoploss First Dollar + Reimbursement Rate 72.00 + Basic Per Diem + Fixed Rate 10000.00 + Fixed Amount 56687.00,,,,0,other,NTE Percentage + Reimbursement Rate 85.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,Ungroupable,,,,0,other,Ungroupable + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Ungroupable,,,,0,other,Ungroupable + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Ungroupable,,,,0,other,Ungroupable + No services performed during 15-month lookback period,,,Stoploss First Dollar + Reimbursement Rate 52.80 + Basic Per Diem + Fixed Rate 1292.00 + Fixed Amount 56100.00,,,,0,other,Stoploss First Dollar + Reimbursement Rate 52.80 + Basic Per Diem + Fixed Rate 1292.00 + Fixed Amount 56100.00 + No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Ungroupable,,,,0,other,Ungroupable + No services performed during 15-month lookback period,,,Ungroupable,,,,0,other,Ungroupable + No services performed during 15-month lookback period,,47.3,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Ungroupable,,,,0,other,Ungroupable + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Ungroupable,,,,0,other,Ungroupable + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Ungroupable,,,,0,other,Ungroupable + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Ungroupable,,,,0,other,Ungroupable + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6084,,,,,,,per diem,,,,Ungroupable,,,,0,other,Ungroupable + No services performed during 15-month lookback period,6084,6084,,facility
BREAST TOMOSYNTHESIS BI,77063,CPT,403,RC,,,,outpatient,,,126,12.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,40.42,40.42,40.42,488,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,40.42,40.42,40.42,77,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,40.42,40.42,40.42,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,225,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,250,,,,,,,case rate,NTE Percentage + Reimbursement Rate 85.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,26.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,58,38.98,61.25,399,percent of total billed charges,,,33.6,,58,38.98,58,151,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,38.98,30.17,58,181,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,26.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,55.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,28.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,58,44.5,58,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,24.36,24.36,24.36,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,26.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,28.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,429,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,27.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,26.75,448,,facility
X-RAY OF MAMMARY DUCT,77053,CPT,320,RC,,,,outpatient,,,198,19.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,235.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,477.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,242.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,242.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,232.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,228.36,477.27,,facility
BREAST TOMOSYNTHESIS UNI,77061,CPT,401,RC,,,,outpatient,,,120,12,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,225,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,250,,,,,,,case rate,NTE Percentage + Reimbursement Rate 85.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,429,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,225,448,,facility
ULTRASOUND BREAST LIMITED,76642,CPT,402,RC,,,,outpatient,,,78,7.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,85.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,174.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,42.34,42.34,44.13,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,465,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,84.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,83.29,465,,facility
ULTRASOUND BREAST COMPLETE,76641,CPT,402,RC,,,,outpatient,,,78,7.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,465,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,465,,facility
MOPATH PROCEDURE LEVEL 7,81406,CPT,310,RC,,,,outpatient,,,81,8.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,282.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,282.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,291.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,282.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,591.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,299.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,282.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,299.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,495.04,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,288.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,282.88,591.22,,facility
BX BREAST PERCUT W/O IMAGE,19100,CPT,761,RC,,,,outpatient,,,65,6.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1628.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3303.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1675.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1675.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,1612.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3303.62,,facility
TUMOR IMMUNOHISTOCHEM/MANUAL,88360,CPT,310,RC,,,,outpatient,,,81,8.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,150.35,150.35,163.06,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,82.41,82.41,329.64,11,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,167.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,159.24,53.08,234.83,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,106.16,48.38,351.46,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,340.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,172.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,261.5,261.5,261.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,60.48,60.48,109.83,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,63.93,63.93,66.9,16,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,172.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,377,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,166.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,163.06,448,,facility
SCR MAMMO BI INCL CAD,77067,CPT,403,RC,,,,outpatient,,,126,12.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,130.54,130.54,130.54,490,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,130.54,130.54,130.54,77,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,130.54,130.54,130.54,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,225,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,250,,,,,,,case rate,NTE Percentage + Reimbursement Rate 85.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,33.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,33.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,34.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,297.5,199.92,314.16,399,percent of total billed charges,,,33.6,,297.5,199.92,297.5,151,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,199.92,155.26,297.5,181,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,33.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,70.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,297.5,229,297.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,124.95,124.95,124.95,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,33.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,429,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,34.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,33.81,448,,facility
MOPATH PROCEDURE LEVEL 3,81402,CPT,310,RC,,,,outpatient,,,81,8.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,150.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,150.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,154.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,150.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,314.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,159.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,150.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,159.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,263.08,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,153.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,150.33,448,,facility
IMHCHEM/IMCYTCHM EA ADD ANTB,88341,CPT,310,RC,,,,outpatient,,,81,8.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,253.44,84.48,824.32,63,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,155.76,77.88,233.64,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,432.77,216.38,1514.69,32,percent of total billed charges,,,33.6,,330,209.09,2163.84,23,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,432.77,44.35,1298.3,46,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,25.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,53.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,27.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,1610,1610,1610,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,55.86,53.04,55.86,82,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,25.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,27.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,113.4,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,26.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,25.79,448,,facility
IMHCHEM/IMCYTCHM 1ST ANTB,88342,CPT,310,RC,,,,outpatient,,,81,8.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,150.35,150.35,163,21,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,412.16,68.86,412.16,25,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,379.96,379.96,379.96,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,167.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,289.16,216.38,432.77,28,percent of total billed charges,,,33.6,,216.38,43.79,340.03,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,216.38,216.38,218.32,28,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,340.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,172.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,322,322,644,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,63.66,60.24,63.66,181,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,172.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,377,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,166.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,163.06,448,,facility
NJX PX ONLY MAM DUCTO/GLCTO,19030,CPT,361,RC,,,,outpatient,,,198,19.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,62.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,62.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,63.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,62.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,129.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,65.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,62.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,65.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2440,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,63.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,62.01,2440,,facility
ASSAY OF PSA FREE,84154,CPT,301,RC,,,,outpatient,,,77,7.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.36,16.36,16.36,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,32.74,32.74,42.77,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,5.71,5.71,5.71,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.36,16.36,16.36,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,39.74,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.39,448,,facility
ASSAY OF FREE THYROXINE,84439,CPT,301,RC,,,,outpatient,,,38,3.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,8.02,8.02,8.02,335,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,53.1,53.1,309.16,13,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,47.52,30.24,276.67,112,percent of total billed charges,,,33.6,,47.52,30.24,276.67,25,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,30.24,30.24,176.06,119,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,9.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,18.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,9.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,45.13,45,262,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,18.9,18.9,18.9,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,8.02,8.02,8.02,954,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,9.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,9.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.48,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,9.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,9.02,448,,facility
COLL VENOUS BLD VENIPUNCTURE,36415,CPT,300,RC,,,,outpatient,,,27,2.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,8.09,8.09,8.31,58,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,10.91,9.28,57.6,227,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,12.73,8.56,79.9,21,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,90,90,90,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,51.39,30.24,51.39,230,percent of total billed charges,,,33.6,,30.24,5.04,51.39,24,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,30.24,30.24,30.51,106,percent of total billed charges,,,34.6,,32.69,32.69,32.69,1 through 10,percent of total billed charges,,,45,,8.09,8.09,8.09,1 through 10,percent of total billed charges,,9.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,19.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,9.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,7.5,7.25,45,119,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,18.9,3.15,18.9,49,percent of total billed charges,,,35,,45,45,45,1 through 10,percent of total billed charges,,,40,,15,8.09,90,1 through 10,percent of total billed charges,,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,8.09,8.09,8.31,11157,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,9.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,9.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.25,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,9.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.25,448,,facility
RUBEOLA ANTIBODY,86765,CPT,302,RC,,,,outpatient,,,147,14.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.46,11.46,11.46,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,22.18,22.18,83.95,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,20.68,20.68,20.68,1 through 10,percent of total billed charges,,,34.6,,61.35,61.35,61.35,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,26.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,44,44,44,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.46,11.46,11.46,18,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.88,448,,facility
LACTATE (LD) (LDH) ENZYME,83615,CPT,301,RC,,,,outpatient,,,27,2.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.37,5.37,5.37,60,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,38.94,38.94,38.94,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,34.85,11.09,34.85,38,percent of total billed charges,,,33.6,,22.18,22.18,22.18,46,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,20.95,20.95,22.18,22,percent of total billed charges,,,34.6,,23.96,20.95,25.15,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,12.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,13.86,13.86,13.86,17,percent of total billed charges,,,35,,27.5,27.5,27.5,1 through 10,percent of total billed charges,,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.37,5.37,5.37,235,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.04,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,6.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,6.04,448,,facility
FREE ASSAY (FT-3),84481,CPT,301,RC,,,,outpatient,,,72,7.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.07,15.07,15.07,40,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,93.81,93.81,276.71,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,83.95,53.42,157.58,12,percent of total billed charges,,,33.6,,53.42,53.42,157.58,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,53.42,53.42,157.58,33,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,35.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.07,15.07,15.07,127,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.61,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,16.94,448,,facility
URINE CULTURE/COLONY COUNT,87086,CPT,306,RC,,,,outpatient,,,40,4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,7.18,7.18,7.18,21,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,65.92,35.84,65.92,12,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,46.61,33.04,143.37,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,54.38,34.61,58.81,1 through 10,percent of total billed charges,,,33.6,,32.04,32.04,34.61,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,34.61,18.82,34.61,12,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,16.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,51.5,51.5,51.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,21.63,21.63,21.63,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,7.18,7.18,7.18,106,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.43,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,8.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,8.07,448,,facility
ASSAY OF TOTAL ESTRADIOL,82670,CPT,301,RC,,,,outpatient,,,138,13.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,24.85,24.85,24.85,51,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,47.79,39.12,263.73,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,42.77,42.77,42.77,15,percent of total billed charges,,,33.6,,42.77,27.46,236.02,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,27.46,27.22,150.19,27,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,27.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,58.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,29.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,40.5,40.5,40.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,17.01,17.01,17.01,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,24.85,24.85,24.85,85,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,27.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,29.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,60.36,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,28.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,27.94,448,,facility
ASSAY OF PSA TOTAL,84153,CPT,301,RC,,,,outpatient,,,77,7.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.36,16.36,16.36,28,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,49.86,25.75,175.82,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,100.13,28.56,157.34,43,percent of total billed charges,,,33.6,,100.13,28.56,101.02,12,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,28.56,28.56,101.02,71,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,42.5,42.5,42.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,17.85,17.85,17.85,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.36,16.36,16.36,55,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,39.74,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.39,448,,facility
IMMUNOASSAY QUANT NOS NONAB,83520,CPT,301,RC,,,,outpatient,,,59,5.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,36,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,66.08,66.08,66.08,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,41.18,24.82,318.38,1 through 10,percent of total billed charges,,,33.6,,37.63,37.63,96.43,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,33.6,23.18,176.4,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,36.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,87,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.22,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.27,448,,facility
VITAMIN D 25 HYDROXY,82306,CPT,301,RC,,,,outpatient,,,123,12.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,26.33,26.33,26.33,345,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,123.9,123.9,399.43,17,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,110.88,70.56,357.46,103,percent of total billed charges,,,33.6,,71.19,70.56,227.47,16,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,70.56,70.56,227.47,175,percent of total billed charges,,,34.6,,257.94,257.94,257.94,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,29.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,61.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,31.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,105,105,338.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,142.17,44.1,142.17,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,26.33,26.33,26.33,1001,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,29.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,31.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,63.96,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,30.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,29.6,448,,facility
ASSAY OF MAGNESIUM,83735,CPT,301,RC,,,,outpatient,,,34,3.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.96,5.96,5.96,292,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,9.38,5.96,25.37,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,197.47,22.7,213.55,144,percent of total billed charges,,,33.6,,125.66,125.66,126.79,59,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,125.66,14.45,142.49,154,percent of total billed charges,,,34.6,,135.76,135.76,142.49,1 through 10,percent of total billed charges,,,45,,5.96,5.96,5.96,1 through 10,percent of total billed charges,,6.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,7.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,21.5,21.5,187,13,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,78.54,78.54,78.54,21,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.96,5.96,5.96,1555,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,7.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.47,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,6.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,6.7,448,,facility
BASIC METABOLIC PNL TOTAL CA,80048,CPT,301,RC,,,,outpatient,,,41,4.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,7.53,7.53,7.53,173,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,25.96,11.84,443.68,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,28.16,28.16,28.16,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,254.93,23.23,429.39,147,percent of total billed charges,,,33.6,,252.67,14.78,429.39,26,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,14.92,14.78,252.67,149,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,17.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,22,22,376,21,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,9.24,9.24,157.92,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,7.53,7.53,7.53,1135,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.27,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,8.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,8.46,448,,facility
ANTISTREPTOLYSIN O TITER,86060,CPT,302,RC,,,,outpatient,,,32,3.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,40.99,40.99,40.99,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,7.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,15.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,7.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,6.49,6.49,6.49,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,7.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,7.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.77,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,7.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,7.3,448,,facility
VITAMIN B-12,82607,CPT,301,RC,,,,outpatient,,,63,6.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.41,13.41,13.41,130,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,57.82,57.82,193.52,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,51.74,32.93,173.18,47,percent of total billed charges,,,33.6,,32.93,32.93,110.21,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,32.93,32.93,33.22,71,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,31.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,49,49,49,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,68.88,68.88,68.88,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.41,13.41,13.41,332,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.57,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,15.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,15.08,448,,facility
ASSAY OF FERRITIN,82728,CPT,301,RC,,,,outpatient,,,58,5.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.12,12.12,12.12,348,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,56.64,56.64,185.26,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,50.69,32.26,165.79,96,percent of total billed charges,,,33.6,,32.26,32.26,165.79,18,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,32.26,32.26,105.5,115,percent of total billed charges,,,34.6,,116.18,116.18,116.18,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,28.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,48,48,48,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,65.94,20.16,65.94,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.12,12.12,12.12,882,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.45,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.63,448,,facility
ASSAY OF TRANSFERRIN,84466,CPT,301,RC,,,,outpatient,,,54,5.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.35,11.35,11.35,19,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,63.57,63.57,63.57,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,57.02,36.29,217.54,41,percent of total billed charges,,,33.6,,36.29,36.29,217.54,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,36.53,36.29,138.43,42,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,26.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,54,53.88,54,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.35,11.35,11.35,63,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.58,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.76,448,,facility
LIPID PANEL,80061,CPT,301,RC,,,,outpatient,,,66,6.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.91,11.91,11.91,1021,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,34.81,34.81,34.81,26,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,37.76,37.76,37.76,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,31.15,19.82,31.15,172,percent of total billed charges,,,33.6,,20,19.82,31.15,37,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,19.82,19.82,20,389,percent of total billed charges,,,34.6,,21.83,21.83,21.83,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,29.5,29.5,123.5,11,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,12.39,12.39,51.87,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.91,11.91,11.91,1133,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.93,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.39,448,,facility
PREV VISIT NEW AGE 18-39,99385,CPT,770,RC,,,,outpatient,,,451,45.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,81.59,81.59,81.59,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
VIT D 1 25-DIHYDROXY,82652,CPT,301,RC,,,,outpatient,,,160,16,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,34.25,34.25,34.25,16,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,30.68,30.68,30.68,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,39.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,41.71,17.47,46.99,1 through 10,percent of total billed charges,,,33.6,,17.47,17.47,29.9,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,26.78,26.54,26.78,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,38.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,80.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,40.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,39.5,39.5,39.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,34.25,34.25,34.25,35,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,38.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,40.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.18,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,39.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,38.5,448,,facility
PREV VISIT EST AGE 18-39,99395,CPT,770,RC,,,,outpatient,,,408,40.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,74.57,74.57,74.57,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
ASSAY OF BLOOD/URIC ACID,84550,CPT,301,RC,,,,outpatient,,,25,2.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.02,4.02,4.02,51,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,23.6,23.6,23.6,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,75.26,21.12,118.27,23,percent of total billed charges,,,33.6,,75.26,75.26,75.26,42,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,75.26,13.44,85.34,40,percent of total billed charges,,,34.6,,81.31,81.31,85.34,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,9.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,47.04,47.04,47.04,18,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.02,4.02,4.02,166,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.77,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,4.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,4.52,448,,facility
PSYTX W PT 45 MINUTES,90834,CPT,914,RC,,,,outpatient,,,318,31.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,140.97,140.97,152.83,52,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,169.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,169.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,174.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,169.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,355.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,180.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,367.5,367.5,367.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,169.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,180.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,173.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,169.87,448,,professional
ASSAY OF SEX HORMONE GLOBUL,84270,CPT,301,RC,,,,outpatient,,,91,9.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.33,19.33,19.33,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,168.43,168.43,182.15,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,108.14,107.18,108.14,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,21.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,45.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,23.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.33,19.33,19.33,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,21.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,23.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,46.95,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,22.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,21.73,448,,facility
COMPREHEN METABOLIC PANEL,80053,CPT,301,RC,,,,outpatient,,,53,5.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9.39,9.39,9.39,1527,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,30.68,30.68,604.75,68,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,33.28,33.28,33.28,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,27.46,17.47,585.27,705,percent of total billed charges,,,33.6,,344.4,17.47,541.2,199,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,17.63,17.47,347.48,855,percent of total billed charges,,,34.6,,372.07,42.7,390.52,33,percent of total billed charges,,,45,,9.39,9.39,9.39,1 through 10,percent of total billed charges,,10.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,22.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,26,26,512.5,60,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,215.25,10.92,215.25,37,percent of total billed charges,,,35,,512.5,512.5,512.5,1 through 10,percent of total billed charges,,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9.39,9.39,9.39,5909,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.82,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,10.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,10.56,448,,facility
COLL VENOUS BLD VENIPUNCTURE,36415,CPT,300,RC,,,,outpatient,,,3.5,0.35,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,8.09,8.09,8.31,58,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,10.91,9.28,57.6,227,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,12.73,8.56,79.9,21,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,90,90,90,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,51.39,30.24,51.39,230,percent of total billed charges,,,33.6,,30.24,5.04,51.39,24,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,30.24,30.24,30.51,106,percent of total billed charges,,,34.6,,32.69,32.69,32.69,1 through 10,percent of total billed charges,,,45,,8.09,8.09,8.09,1 through 10,percent of total billed charges,,9.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,19.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,9.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,7.5,7.25,45,119,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,18.9,3.15,18.9,49,percent of total billed charges,,,35,,45,45,45,1 through 10,percent of total billed charges,,,40,,15,8.09,90,1 through 10,percent of total billed charges,,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,8.09,8.09,8.31,11157,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,9.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,9.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.25,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,9.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.25,448,,facility
COMPREHEN METABOLIC PANEL,80053,CPT,301,RC,,,,outpatient,,,8,0.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9.39,9.39,9.39,1527,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,30.68,30.68,604.75,68,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,33.28,33.28,33.28,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,27.46,17.47,585.27,705,percent of total billed charges,,,33.6,,344.4,17.47,541.2,199,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,17.63,17.47,347.48,855,percent of total billed charges,,,34.6,,372.07,42.7,390.52,33,percent of total billed charges,,,45,,9.39,9.39,9.39,1 through 10,percent of total billed charges,,10.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,22.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,26,26,512.5,60,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,215.25,10.92,215.25,37,percent of total billed charges,,,35,,512.5,512.5,512.5,1 through 10,percent of total billed charges,,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9.39,9.39,9.39,5909,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.82,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,10.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,10.56,448,,facility
NFCT AGT GNTYP ALYS HIV1 REV,87901,CPT,306,RC,,,,outpatient,,,321.81,32.18,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,295,295,295,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,257.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,257.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,265.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,264,264,264,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,257.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,538.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,272.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,229,229,229,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,257.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,272.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,556.22,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,262.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,257.45,556.22,,facility
DRUG/SUBSTANCE NOS 7/MORE,80377,CPT,301,RC,,,,outpatient,,,35,3.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
INTRINSIC FACTOR ANTIBODY,86340,CPT,302,RC,,,,outpatient,,,142,14.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,59.14,59.14,74.98,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,31.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.41,13.41,13.41,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.57,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,15.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,15.08,448,,facility
ASPIRATION OF CYST OF BREAST; FIRST CYST,19000,CPT,0361,RC,,,,outpatient,,,1581,158.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,677.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,677.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,698.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,677.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1416.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,718.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,677.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,718.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2712,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,691.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,2712,,facility
ASSAY OF TOTAL TESTOSTERONE,84403,CPT,301,RC,,,,outpatient,,,9,0.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,22.96,20,22.96,75,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,44.84,11.8,294.41,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,35.9,10.56,263.47,33,percent of total billed charges,,,33.6,,40.13,25.54,169.16,16,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,25.54,6.72,167.66,56,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,25.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,53.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,27.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,38,38,38,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,4.2,4.2,4.2,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,22.96,20,22.96,116,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,25.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,27.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,55.77,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,26.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,25.81,448,,facility
URINE BACTERIA CULTURE,87088,CPT,306,RC,,,,outpatient,,,35,3.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,7.2,7.2,7.2,305,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,314.24,56.32,314.24,57,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,51.92,51.92,289.69,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,259.25,46.46,280.36,74,percent of total billed charges,,,33.6,,164.98,152.74,280.36,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,164.98,29.57,166.45,56,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,16.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,245.5,44.13,245.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,18.53,18.53,103.11,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,7.2,7.2,10.02,1 through 10,percent of total billed charges,,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,7.2,7.2,7.2,951,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.48,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,8.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,8.09,448,,facility
URINALYSIS AUTO W/SCOPE,81001,CPT,307,RC,,,,outpatient,,,16,1.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,2.82,2.82,2.82,418,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,229.76,25.6,256,88,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,211.81,23.6,236,14,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,204.99,21.12,228.4,143,percent of total billed charges,,,33.6,,134.4,21.12,189.55,25,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,121.7,13.44,135.6,151,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,6.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,179.5,20,200,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,8.4,8.4,84,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,2.82,2.82,2.82,1909,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.86,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,3.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,3.17,448,,facility
ASSAY OF FOLIC ACID SERUM,82746,CPT,301,RC,,,,outpatient,,,61,6.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.08,13.08,13.08,44,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,67.11,67.11,227.15,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,60.19,60.19,203.28,1 through 10,percent of total billed charges,,,33.6,,38.56,38.3,129.36,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,38.3,38.3,38.3,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,30.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,57,57,57,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,80.85,80.85,80.85,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.08,13.08,13.08,116,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,31.76,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.7,448,,facility
CT HRT W/O DYE W/CA TEST,75571,CPT,350,RC,,,,outpatient,,,218,21.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,403,,,,,,,case rate,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,371,,,,,,,case rate,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,875,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1050,,,,,,,case rate,NTE Percentage + Reimbursement Rate 85.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,85.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,397.58,397.58,397.58,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,174.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1522,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,84.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,83.29,1522,,facility
PREV VISIT EST AGE 40-64,99396,CPT,770,RC,,,,outpatient,,,433,43.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,122.58,122.58,122.58,1 through 10,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
X-RAY EXAM CHEST 2 VIEWS,71046,CPT,320,RC,,,,outpatient,,,238,23.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,77.25,76.83,83.29,724,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,437.12,437.12,437.12,35,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,402.97,40.3,402.97,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,85.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,360.62,229.49,389.99,46,percent of total billed charges,,,33.6,,229.49,229.49,360.62,13,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,229.49,229.49,231.54,37,percent of total billed charges,,,34.6,,260.22,260.22,260.22,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,174.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,341.5,341.5,341.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,143.43,143.43,143.43,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,18.87,18.87,19.41,574,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,84.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,83.29,448,,facility
ULTRASOUND BREAST LIMITED,76642,CPT,402,RC,,,,outpatient,,,147.84,14.78,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,85.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,174.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,42.34,42.34,44.13,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,465,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,84.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,83.29,465,,facility
ULTRASOUND BREAST COMPLETE,76641,CPT,402,RC,,,,outpatient,,,144.53,14.45,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,465,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,465,,facility
ULTRASOUND BREAST COMPLETE,76641,CPT,402,RC,,,,outpatient,,,216.8,21.68,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,465,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,465,,facility
ULTRASOUND BREAST LIMITED,76642,CPT,402,RC,,,,outpatient,,,221.76,22.18,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,85.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,174.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,42.34,42.34,44.13,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,465,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,84.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,83.29,465,,facility
"TOMOSYNTHESIS, MAMMO",G0279,HCPCS,401,RC,,,,outpatient,,,19.65,1.97,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,225,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,250,,,,,,,case rate,NTE Percentage + Reimbursement Rate 85.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,26.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,26.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,55.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,28.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,26.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,28.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,429,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,27.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,26.75,448,,facility
DXA BONE DENSITY AXIAL,77080,CPT,320,RC,,,,outpatient,,,106.11,10.61,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,39.86,39.86,39.86,32,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,39.86,39.86,39.86,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,151.2,57.61,237.6,26,percent of total billed charges,,,33.6,,57.61,57.61,57.61,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,117.29,57.61,151.2,15,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,448,,facility
NUCLEAR ANTIGEN ANTIBODY,86235,CPT,302,RC,,,,outpatient,,,46,4.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13,12.5,15.95,11,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,54.91,4.37,90.29,43,percent of total billed charges,,,33.6,,4.37,4.37,53.09,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,22.18,4.24,83.33,13,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,37.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.95,13,15.95,54,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.75,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.93,448,,facility
BODY FLUID CELL COUNT,89051,CPT,309,RC,,,,outpatient,,,18,1.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,503.78,376.99,592.42,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,11.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.98,4.98,4.98,47,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.9,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.6,448,,facility
DRUG SCREENING COCAINE,80353,CPT,301,RC,,,,outpatient,,,35,3.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
HSV DNA AMP PROBE,87529,CPT,306,RC,,,,outpatient,,,82.3,8.23,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,244.61,244.61,244.61,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
ANTI-PHOSPHOLIPID ANTIBODY,86148,CPT,302,RC,,,,outpatient,,,43.65,4.37,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,14.29,14.29,14.29,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,33.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,34.72,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,16.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,16.07,448,,facility
ASSAY OF CADMIUM,82300,CPT,301,RC,,,,outpatient,,,90,9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,23.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,23.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,23.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,49.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,25.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,21.03,21.03,21.03,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,23.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,25.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,50.02,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,24.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,23.64,448,,facility
PMS2 GENE DUP/DELET VARIANTS,81319,CPT,310,RC,,,,outpatient,,,144,14.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,203.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,203.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,209.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,203.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,425.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,215.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,203.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,215.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,356.13,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,207.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,203.5,448,,facility
SPECIMEN INFECT AGNT CONCNTJ,87015,CPT,306,RC,,,,outpatient,,,41,4.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.94,5.94,5.94,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,13.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,7.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.94,5.94,5.94,23,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,7.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.42,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,6.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,6.68,448,,facility
IMMUNFIX E-PHORSIS/URINE/CSF,86335,CPT,302,RC,,,,outpatient,,,46.6,4.66,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,26.11,26.11,26.11,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,25.76,25.76,25.76,1 through 10,percent of total billed charges,,,34.6,,56.99,56.99,56.99,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,29.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,61.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,31.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,26.11,26.11,26.11,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,29.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,31.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,63.4,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,29.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,29.35,448,,facility
CARDIOLIPIN ANTIBODY EA IG,86147,CPT,302,RC,,,,outpatient,,,46.9,4.69,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,22.64,22.64,22.64,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,72.86,42.34,163.68,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,50.06,50.06,137.76,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,25.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,53.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,26.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,22.64,22.64,22.64,31,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,25.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,26.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,54.99,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,25.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,25.45,448,,facility
HIV-1 AG W/HIV-1&-2 AB AG IA,87389,CPT,306,RC,,,,outpatient,,,35,3.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,21.42,21.42,21.42,263,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,35.4,35.4,35.4,16,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,31.68,20.16,31.68,80,percent of total billed charges,,,33.6,,20.34,20.16,31.68,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,20.16,20.16,20.34,158,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,24.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,50.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,25.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,30,30,30,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,21.42,21.42,21.42,1 through 10,percent of total billed charges,,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,21.42,21.42,21.42,533,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,24.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,25.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,52.03,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,24.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,24.08,448,,facility
EHRLICHIA ANTIBODY,86666,CPT,302,RC,,,,outpatient,,,37,3.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,7.53,7.53,7.53,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,21.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9.05,9.05,9.05,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.98,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,10.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,10.18,448,,facility
METHYLENEDIOXYAMPHETAMINES,80359,CPT,301,RC,,,,outpatient,,,268,26.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
CHROMOGENIC SUBSTRATE ASSAY,85130,CPT,305,RC,,,,outpatient,,,172,17.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.58,10.58,10.58,11,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,571.12,571.12,571.12,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,277.2,277.2,277.2,1 through 10,percent of total billed charges,,,33.6,,176.4,176.4,176.4,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,24.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.58,10.58,10.58,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.69,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.89,448,,facility
ASSAY GLUCOSE BLOOD QUANT,82947,CPT,301,RC,,,,outpatient,,,25,2.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.5,3.5,3.5,64,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,14.08,14.08,14.08,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,49.11,28.9,49.11,12,percent of total billed charges,,,33.6,,28.9,28.9,28.9,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,7.46,7.39,56.98,14,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,8.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,43,43,43,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.5,3.5,3.5,54,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.49,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,4.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,3.93,448,,facility
CACNA1A GENE FULL GENE SEQ,81185,CPT,310,RC,,,,outpatient,,,414,41.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,846.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,846.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,871.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,846.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1768.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,897.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,846.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,897.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1480.97,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,863.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1768.7,,facility
LYME DISEASE ANTIBODY,86618,CPT,302,RC,,,,outpatient,,,24.6,2.46,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,35.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.15,15.15,15.15,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.79,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.03,448,,facility
BETA-2 GLYCOPROTEIN ANTIBODY,86146,CPT,302,RC,,,,outpatient,,,119,11.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,22.64,22.64,22.64,11,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,90.82,24.82,293.57,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,57.79,57.79,186.82,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,25.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,53.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,26.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,128.1,128.1,128.1,1 through 10,percent of total billed charges,,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,22.64,22.64,22.64,25,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,25.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,26.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,54.99,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,25.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,25.45,448,,facility
DETECT AGENT NOS DNA AMP,87798,CPT,306,RC,,,,outpatient,,,111,11.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,110.88,110.88,174.24,1 through 10,percent of total billed charges,,,33.6,,244.27,244.27,244.27,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,96.77,32.38,119.79,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,38.9,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
DNA ANTIBODY NATIVE,86225,CPT,302,RC,,,,outpatient,,,62.5,6.25,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.22,12.22,12.22,16,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,32.21,29.57,46.46,11,percent of total billed charges,,,33.6,,29.57,29.57,29.57,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,29.66,29.57,98.11,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,28.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.22,12.22,12.22,49,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.7,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.74,448,,facility
ASSAY BLD/SERUM CHOLESTEROL,82465,CPT,301,RC,,,,outpatient,,,33,3.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.87,3.87,3.87,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,20.83,20.83,20.83,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,9.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.87,3.87,3.87,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.4,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,4.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,4.35,448,,facility
DRUG/SUBSTANCE NOS 7/MORE,80377,CPT,301,RC,,,,outpatient,,,40,4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
HIV-1 PROBE&REVERSE TRNSCRPJ,87535,CPT,306,RC,,,,outpatient,,,510,51,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,122.13,122.13,122.13,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,38.98,38.98,61.25,1 through 10,percent of total billed charges,,,33.6,,618.82,618.82,618.82,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,38.48,38.48,42.11,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
ASSAY OF MERCURY,83825,CPT,301,RC,,,,outpatient,,,41.25,4.13,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,14.46,14.46,14.46,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,33.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,14.46,14.46,14.46,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.12,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,16.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,16.26,448,,facility
ASSAY CARBOXYHB QUANT,82375,CPT,301,RC,,,,outpatient,,,7,0.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.96,10.96,10.96,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.62,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.32,448,,facility
UNLISTED MOLECULAR PATHOLOGY,81479,CPT,310,RC,,,,outpatient,,,1045,104.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,561.56,561.56,561.56,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,32.5,32.5,3071.5,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
VARICELLA-ZOSTER ANTIBODY,86787,CPT,302,RC,,,,outpatient,,,50.25,5.03,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.46,11.46,11.46,39,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,82.6,23.01,82.6,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,47.54,20.59,129.19,22,percent of total billed charges,,,33.6,,47.04,47.04,266.64,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,47.04,47.04,47.54,21,percent of total billed charges,,,34.6,,221.19,221.19,221.19,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,26.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,70,70,252.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,24.36,24.36,24.36,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,11.46,11.46,11.46,1 through 10,percent of total billed charges,,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.46,11.46,11.46,200,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.88,448,,facility
COLLAGEN CROSSLINKS,82523,CPT,301,RC,,,,outpatient,,,84.9,8.49,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,39.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.62,16.62,16.62,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,40.37,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.68,448,,facility
ENZYME CELL ACTIVITY,82657,CPT,301,RC,,,,outpatient,,,127.5,12.75,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.72,19.72,19.72,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,2094.14,2094.14,2094.14,1 through 10,percent of total billed charges,,,33.6,,762.96,762.96,762.96,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,46.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,23.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.72,19.72,19.72,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,23.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,39.01,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,22.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,22.17,448,,facility
ASSAY OF TOBRAMYCIN,80200,CPT,301,RC,,,,outpatient,,,18,1.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,33.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,34.84,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,16.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,16.13,448,,facility
IMMUNOASSAY QUANT NOS NONAB,83520,CPT,301,RC,,,,outpatient,,,156,15.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,36,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,66.08,66.08,66.08,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,41.18,24.82,318.38,1 through 10,percent of total billed charges,,,33.6,,37.63,37.63,96.43,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,33.6,23.18,176.4,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,36.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,87,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.22,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.27,448,,facility
HERPES SIMPLEX TYPE 2 TEST,86696,CPT,302,RC,,,,outpatient,,,157,15.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,17.21,17.21,17.21,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,20.59,20.59,42.71,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,13.1,13.1,13.1,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,40.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,20.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,17.21,17.21,17.21,12,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,20.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,41.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,19.35,448,,facility
MYCOPLASMA ANTIBODY,86738,CPT,302,RC,,,,outpatient,,,30,3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.78,11.78,11.78,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.6,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.24,448,,facility
CLOT FACTOR XIII FIBRIN STAB,85290,CPT,305,RC,,,,outpatient,,,78.75,7.88,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,14.53,14.53,14.53,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,34.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,14.53,14.53,14.53,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.3,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,16.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,16.34,448,,facility
COLL VENOUS BLD VENIPUNCTURE,36415,CPT,300,RC,,,,outpatient,,,6,0.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,8.09,8.09,8.31,58,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,10.91,9.28,57.6,227,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,12.73,8.56,79.9,21,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,90,90,90,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,51.39,30.24,51.39,230,percent of total billed charges,,,33.6,,30.24,5.04,51.39,24,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,30.24,30.24,30.51,106,percent of total billed charges,,,34.6,,32.69,32.69,32.69,1 through 10,percent of total billed charges,,,45,,8.09,8.09,8.09,1 through 10,percent of total billed charges,,9.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,19.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,9.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,7.5,7.25,45,119,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,18.9,3.15,18.9,49,percent of total billed charges,,,35,,45,45,45,1 through 10,percent of total billed charges,,,40,,15,8.09,90,1 through 10,percent of total billed charges,,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,8.09,8.09,8.31,11157,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,9.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,9.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.25,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,9.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.25,448,,facility
IMMUNOASSAY QUANT NOS NONAB,83520,CPT,301,RC,,,,outpatient,,,185.6,18.56,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,36,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,66.08,66.08,66.08,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,41.18,24.82,318.38,1 through 10,percent of total billed charges,,,33.6,,37.63,37.63,96.43,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,33.6,23.18,176.4,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,36.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,87,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.22,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.27,448,,facility
ASSAY OF PRIMIDONE,80188,CPT,301,RC,,,,outpatient,,,19.25,1.93,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,34.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.84,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,16.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,16.59,448,,facility
ASSAY OF TOTAL ESTRADIOL,82670,CPT,301,RC,,,,outpatient,,,22,2.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,24.85,24.85,24.85,51,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,47.79,39.12,263.73,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,42.77,42.77,42.77,15,percent of total billed charges,,,33.6,,42.77,27.46,236.02,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,27.46,27.22,150.19,27,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,27.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,58.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,29.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,40.5,40.5,40.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,17.01,17.01,17.01,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,24.85,24.85,24.85,85,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,27.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,29.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,60.36,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,28.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,27.94,448,,facility
ASSAY OF PYRUVATE KINASE,84220,CPT,301,RC,,,,outpatient,,,62,6.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,9.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,19.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,8.4,8.4,8.4,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,9.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.41,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,9.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,9.44,448,,facility
ASSAY OF TOPIRAMATE,80201,CPT,301,RC,,,,outpatient,,,71.6,7.16,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,24.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.6,10.6,10.6,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.76,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.92,448,,facility
RIA NONANTIBODY,83519,CPT,301,RC,,,,outpatient,,,365,36.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,55.44,55.44,55.44,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.37,16.37,16.37,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.2,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.4,448,,facility
BLOOD PRODUCT/IRRADIATION,86945,CPT,302,RC,,,,outpatient,,,83.5,8.35,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,74.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,55.65,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,36.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.74,448,,facility
DETECT AGENT NOS DNA AMP,87798,CPT,306,RC,,,,outpatient,,,496.7,49.67,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,110.88,110.88,174.24,1 through 10,percent of total billed charges,,,33.6,,244.27,244.27,244.27,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,96.77,32.38,119.79,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,38.9,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
CARDIOLIPIN ANTIBODY EA IG,86147,CPT,302,RC,,,,outpatient,,,9.8,0.98,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,22.64,22.64,22.64,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,72.86,42.34,163.68,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,50.06,50.06,137.76,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,25.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,53.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,26.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,22.64,22.64,22.64,31,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,25.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,26.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,54.99,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,25.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,25.45,448,,facility
ASSAY OF VITAMIN B-6,84207,CPT,301,RC,,,,outpatient,,,58.15,5.82,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,24.99,24.99,24.99,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,48.53,48.53,48.53,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,43.43,43.43,43.43,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,27.55,18.82,27.55,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,28.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,58.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,29.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,24.99,24.99,24.99,18,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,28.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,29.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,60.71,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,28.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,28.1,448,,facility
ASSAY OF URINE POTASSIUM,84133,CPT,301,RC,,,,outpatient,,,36,3.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.21,4.21,4.21,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,22.51,22.51,22.71,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,9.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,9.5,9.5,33.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.21,4.21,4.21,20,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.31,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,4.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,4.73,448,,facility
MOPATH PROCEDURE LEVEL 5,81404,CPT,310,RC,,,,outpatient,,,105,10.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,274.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,274.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,283.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,274.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,574.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,291.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,274.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,291.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,480.95,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,280.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,274.83,574.39,,facility
T CELL ABSOLUTE COUNT,86361,CPT,302,RC,,,,outpatient,,,238,23.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,23.82,23.82,23.82,46,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,160.48,160.19,463.15,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,143.62,91.39,143.62,24,percent of total billed charges,,,33.6,,143.62,91.39,414.48,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,91.39,91.39,92.04,15,percent of total billed charges,,,34.6,,284.95,284.95,284.95,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,26.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,55.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,28.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,136,135.75,136,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,23.82,23.82,23.82,197,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,26.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,28.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,57.86,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,27.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,26.78,448,,facility
UNLISTED MOLECULAR PATHOLOGY,81479,CPT,310,RC,,,,outpatient,,,75,7.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,561.56,561.56,561.56,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,32.5,32.5,3071.5,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
DETECT AGNT MULT DNA AMPLI,87801,CPT,306,RC,,,,outpatient,,,351,35.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,70.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,70.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,72.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,70.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,146.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,74.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,62.44,62.44,62.44,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,70.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,74.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,151.66,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,71.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,70.2,448,,facility
ASSAY OF LIPOPROTEIN,83718,CPT,301,RC,,,,outpatient,,,4,0.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,7.28,7.28,7.28,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,17.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.71,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,8.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,8.19,448,,facility
COL CHROMOTOGRAPHY QUAL/QUAN,82542,CPT,301,RC,,,,outpatient,,,413,41.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,21.43,21.43,21.43,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,435.07,435.07,435.07,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,24.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,50.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,25.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,21.43,21.43,21.43,15,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,24.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,25.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.16,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,24.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,24.09,448,,facility
MUSCLE-SPECIFIC KINASE ANTB,86366,CPT,302,RC,,,,outpatient,,,910,91,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.37,16.37,16.37,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.2,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.4,448,,facility
M. GENITALIUM AMP PROBE,87563,CPT,306,RC,,,,outpatient,,,153,15.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,61.41,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
ASSAY TEST FOR BLOOD FECAL,82274,CPT,301,RC,,,,outpatient,,,60,6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,33.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,34.37,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,16.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,15.92,448,,facility
EXAM SYNOVIAL FLUID CRYSTALS,89060,CPT,309,RC,,,,outpatient,,,14,1.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,90.38,90.38,90.38,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,90.38,90.38,90.38,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,7.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,15.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,7.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,6.52,6.52,6.52,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,7.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,7.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.45,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,7.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,7.33,448,,facility
MASS SPECTROMETRY QUAL/QUAN,83789,CPT,301,RC,,,,outpatient,,,110,11,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,24.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,50.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,25.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,24.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,25.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.19,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,24.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,24.11,448,,facility
DEHYDROEPIANDROSTERONE,82627,CPT,301,RC,,,,outpatient,,,53.05,5.31,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.77,19.77,19.77,24,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,44.25,44.25,44.25,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,39.6,39.6,142.03,1 through 10,percent of total billed charges,,,33.6,,25.2,25.2,25.2,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,25.2,25.2,90.38,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,46.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,23.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.77,19.77,19.77,42,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,23.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,48.04,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,22.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,22.23,448,,facility
ASSAY OF PHENYTOIN TOTAL,80185,CPT,301,RC,,,,outpatient,,,108,10.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,70.22,70.22,70.22,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,44.69,44.69,44.69,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.79,11.79,11.79,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.63,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.25,448,,facility
EMA EACH IG CLASS,86231,CPT,302,RC,,,,outpatient,,,47,4.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9,9,9,55,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,5.31,5.31,24.19,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,4.75,3.05,21.65,17,percent of total billed charges,,,33.6,,3.02,3.02,3.02,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,3.02,3.02,3.05,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,4.5,4.5,4.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9,9,10.75,200,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.16,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.09,448,,facility
APC GENE DUP/DELET VARIANTS,81203,CPT,310,RC,,,,outpatient,,,72,7.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,200,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,200,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,206,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,200,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,418,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,212,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,200,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,212,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,350,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,204,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,200,448,,facility
PALB2 GENE FULL GENE SEQ,81307,CPT,310,RC,,,,outpatient,,,262,26.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,676.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,676.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,696.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,676.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1413.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,717.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,676.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,717.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,495.04,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,690.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1413.88,,facility
HEPARIN NEUTRALIZATION,85525,CPT,305,RC,,,,outpatient,,,310,31,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,24.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.59,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.84,448,,facility
QUANTITATIVE ASSAY DRUG,80299,CPT,301,RC,,,,outpatient,,,64,6.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,13,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,174.64,174.64,174.64,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,171.6,171.6,171.6,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,374.52,374.52,374.52,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.62,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.64,448,,facility
COMPREHEN METABOLIC PANEL,80053,CPT,301,RC,,,,outpatient,,,7,0.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9.39,9.39,9.39,1527,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,30.68,30.68,604.75,68,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,33.28,33.28,33.28,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,27.46,17.47,585.27,705,percent of total billed charges,,,33.6,,344.4,17.47,541.2,199,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,17.63,17.47,347.48,855,percent of total billed charges,,,34.6,,372.07,42.7,390.52,33,percent of total billed charges,,,45,,9.39,9.39,9.39,1 through 10,percent of total billed charges,,10.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,22.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,26,26,512.5,60,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,215.25,10.92,215.25,37,percent of total billed charges,,,35,,512.5,512.5,512.5,1 through 10,percent of total billed charges,,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9.39,9.39,9.39,5909,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.82,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,10.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,10.56,448,,facility
QUANTITATIVE ASSAY DRUG,80299,CPT,301,RC,,,,outpatient,,,37,3.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,13,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,174.64,174.64,174.64,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,171.6,171.6,171.6,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,374.52,374.52,374.52,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.62,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.64,448,,facility
CHLAMYDIA CULTURE,87110,CPT,306,RC,,,,outpatient,,,24.5,2.45,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,40.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,20.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,20.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.33,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,19.6,448,,facility
HTLV/HIV CONFIRMJ ANTIBODY,86689,CPT,302,RC,,,,outpatient,,,154.75,15.48,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,40.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,20.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,20.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,41.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,19.35,448,,facility
THROMBOPLASTIN TIME PARTIAL,85732,CPT,305,RC,,,,outpatient,,,35,3.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.75,5.75,5.75,18,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,24.29,15.46,83.95,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,15.46,15.46,15.46,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,13.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.75,5.75,5.75,33,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.97,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,6.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,6.47,448,,facility
MOPATH PROCEDURE LEVEL 6,81405,CPT,310,RC,,,,outpatient,,,131,13.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,301.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,301.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,310.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,301.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,629.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,319.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,301.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,319.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,527.36,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,307.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,301.35,629.82,,facility
ASSAY OF CHROMIUM,82495,CPT,301,RC,,,,outpatient,,,63.8,6.38,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,20.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,42.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,21.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,20.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,21.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,43.82,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,20.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,20.28,448,,facility
ANALYSIS FOR ANTIBODY TO RUBEOLA (MEASLES VIRUS),86765,CPT,0302,RC,,,,outpatient,,,61,6.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.46,11.46,11.46,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,22.18,22.18,83.95,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,20.68,20.68,20.68,1 through 10,percent of total billed charges,,,34.6,,61.35,61.35,61.35,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,26.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,44,44,44,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.46,11.46,11.46,18,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.88,448,,facility
SC STD ENZYME DETCJ PER NZM,87185,CPT,306,RC,,,,outpatient,,,2.1,0.21,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.23,4.23,4.23,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,9.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.23,4.23,4.23,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.26,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,4.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,4.75,448,,facility
DRUG SCREENING TRAMADOL,80373,CPT,301,RC,,,,outpatient,,,166.5,16.65,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
M.PNEUMON DNA AMP PROBE,87581,CPT,306,RC,,,,outpatient,,,281,28.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
VIRUS INOCULATION TISSUE,87252,CPT,306,RC,,,,outpatient,,,37,3.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,26.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,54.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,27.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,26.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,27.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,56.32,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,26.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,26.07,448,,facility
CHORIONIC GONADOTROPIN ASSAY,84703,CPT,301,RC,,,,outpatient,,,9,0.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,6.69,6.69,6.69,19,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,23.68,23.68,102.4,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,91.36,19.54,91.36,38,percent of total billed charges,,,33.6,,53.76,49.73,91.36,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,53.76,41.7,53.76,24,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,7.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,15.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,7.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,6.69,6.69,6.69,323,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,7.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,7.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.26,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,7.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,7.52,448,,facility
MOPATH PROCEDURE LEVEL 9,81408,CPT,310,RC,,,,outpatient,,,931,93.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2000,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2000,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2060,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2000,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,4180,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2120,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2000,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2120,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3500,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,2040,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,4180,,facility
DRUG/SUBSTANCE NOS 7/MORE,80377,CPT,301,RC,,,,outpatient,,,117,11.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
T CELL ABSOLUTE COUNT/RATIO,86360,CPT,302,RC,,,,outpatient,,,209,20.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,41.79,41.79,41.79,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,64.31,64.31,64.31,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,46.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,46.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,48.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,31.15,31.15,31.15,1 through 10,percent of total billed charges,,,33.6,,41.79,41.79,41.79,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,288.04,288.04,288.04,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,46.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,98.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,49.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,41.79,41.79,41.79,27,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,46.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,49.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,101.52,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,47.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,46.98,448,,facility
ASSAY OF PYRUVATE,84210,CPT,301,RC,,,,outpatient,,,37.15,3.72,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,30.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.88,12.88,12.88,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.34,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.48,448,,facility
DETECT AGENT NOS DNA QUANT,87799,CPT,306,RC,,,,outpatient,,,468,46.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,38.11,38.11,38.11,39,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,44.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,200.64,91.44,597.79,1 through 10,percent of total billed charges,,,33.6,,203.95,203.95,203.95,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,231.27,203.95,231.27,11,percent of total billed charges,,,34.6,,220.34,220.34,231.27,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,89.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,45.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,38.11,38.11,38.11,221,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,45.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,92.54,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,43.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,42.84,448,,facility
ASSAY OF PHOSPHORUS,84100,CPT,301,RC,,,,outpatient,,,4,0.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.22,4.22,4.22,190,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,19.82,7.39,33.69,48,percent of total billed charges,,,33.6,,19.82,19.82,19.82,43,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,18.67,4.66,19.82,49,percent of total billed charges,,,34.6,,21.42,18.67,22.48,1 through 10,percent of total billed charges,,,45,,4.22,4.22,4.22,1 through 10,percent of total billed charges,,4.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,9.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,7,7,29.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,12.39,12.39,12.39,13,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.22,4.22,4.22,740,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.24,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,4.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,4.74,448,,facility
ASSAY OF TACROLIMUS,80197,CPT,301,RC,,,,outpatient,,,47,4.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.21,12.21,12.21,100,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,71.44,70.9,318.86,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,361.57,70.9,361.57,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,28.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.21,12.21,12.21,313,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.68,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.73,448,,facility
FETAL CHRMOML ANEUPLOIDY,81420,CPT,310,RC,,,,outpatient,,,621,62.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,675.16,675.16,675.16,181,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,1288.32,668.25,1288.32,15,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,1187.67,1187.67,1477.36,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,759.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,759.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,781.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,1062.86,676.37,1062.86,1 through 10,percent of total billed charges,,,33.6,,675.16,675.16,676.37,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,676.37,484.18,682.41,19,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,759.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1586.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,804.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,1006.5,1006.5,1006.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,593.47,593.47,593.47,1 through 10,percent of total billed charges,,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,675.16,675.16,675.16,133,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,759.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,804.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1328.34,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,774.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1586.41,,facility
MOPATH PROCEDURE LEVEL 7,81406,CPT,310,RC,,,,outpatient,,,4300,430,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,282.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,282.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,291.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,282.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,591.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,299.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,282.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,299.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,495.04,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,288.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,282.88,591.22,,facility
FLUORESCENT ANTIBODY TITER,86256,CPT,302,RC,,,,outpatient,,,87,8.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.72,10.72,10.72,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.04,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.05,448,,facility
ASSAY OF CK (CPK),82550,CPT,301,RC,,,,outpatient,,,4,0.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.79,5.79,5.79,26,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,19.47,19.47,19.47,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,54.38,17.42,58.81,37,percent of total billed charges,,,33.6,,34.61,32.04,58.81,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,34.61,11.02,34.62,11,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,13.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,51.5,51.5,51.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.79,5.79,5.79,239,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.07,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,6.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,6.51,448,,facility
CORTISOL FREE,82530,CPT,301,RC,,,,outpatient,,,250,25,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,211.2,211.2,211.2,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,34.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,14.86,14.86,14.86,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.1,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,16.71,448,,facility
COL CHROMOTOGRAPHY QUAL/QUAN,82542,CPT,301,RC,,,,outpatient,,,100.8,10.08,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,21.43,21.43,21.43,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,435.07,435.07,435.07,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,24.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,50.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,25.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,21.43,21.43,21.43,15,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,24.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,25.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.16,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,24.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,24.09,448,,facility
ASSAY OF SOMATOMEDIN,84305,CPT,301,RC,,,,outpatient,,,59.65,5.97,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,18.91,18.91,18.91,22,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,46.61,46.61,46.61,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,41.71,26.54,154.74,1 through 10,percent of total billed charges,,,33.6,,91.06,26.54,143.09,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,91.06,26.54,91.06,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,21.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,44.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,39.5,39.5,39.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,18.91,18.91,18.91,57,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,21.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,45.94,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,21.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,21.26,448,,facility
GLUCOSE TOLERANCE TEST (GTT),82951,CPT,301,RC,,,,outpatient,,,23.22,2.32,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,26.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.81,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.87,448,,facility
NUCLEAR ANTIGEN ANTIBODY,86235,CPT,302,RC,,,,outpatient,,,244,24.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13,12.5,15.95,11,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,54.91,4.37,90.29,43,percent of total billed charges,,,33.6,,4.37,4.37,53.09,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,22.18,4.24,83.33,13,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,37.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.95,13,15.95,54,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.75,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.93,448,,facility
CHLAMYDIA IGM ANTIBODY,86632,CPT,302,RC,,,,outpatient,,,22.5,2.25,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,26.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.41,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.68,448,,facility
ASSAY OF VANCOMYCIN,80202,CPT,301,RC,,,,outpatient,,,28.92,2.89,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,28.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.04,12.04,12.04,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.26,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.54,448,,facility
RUBEOLA ANTIBODY,86765,CPT,302,RC,,,,outpatient,,,105,10.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.46,11.46,11.46,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,22.18,22.18,83.95,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,20.68,20.68,20.68,1 through 10,percent of total billed charges,,,34.6,,61.35,61.35,61.35,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,26.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,44,44,44,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.46,11.46,11.46,18,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.88,448,,facility
CARDIOLIPIN ANTIBODY EA IG,86147,CPT,302,RC,,,,outpatient,,,201,20.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,22.64,22.64,22.64,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,72.86,42.34,163.68,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,50.06,50.06,137.76,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,25.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,53.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,26.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,22.64,22.64,22.64,31,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,25.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,26.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,54.99,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,25.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,25.45,448,,facility
ASSAY BLD/SERUM CHOLESTEROL,82465,CPT,301,RC,,,,outpatient,,,7,0.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.87,3.87,3.87,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,20.83,20.83,20.83,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,9.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.87,3.87,3.87,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.4,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,4.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,4.35,448,,facility
IMMUNOASSAY NONANTIBODY,83516,CPT,301,RC,,,,outpatient,,,73,7.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9,9,10.26,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,4.75,4.75,218.59,30,percent of total billed charges,,,33.6,,3.02,3.02,175.39,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,3.02,3.02,211.68,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,24.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,23.5,23.5,23.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9,9,10.26,51,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.92,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,11.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.53,448,,facility
MEASUREMENT OF ANTIBODY TO NONINFECTIOUS AGENT,86256,CPT,0302,RC,,,,outpatient,,,45,4.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.72,10.72,10.72,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.04,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.05,448,,facility
IMMUNOASSAY NONANTIBODY,83516,CPT,301,RC,,,,outpatient,,,67,6.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9,9,10.26,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,4.75,4.75,218.59,30,percent of total billed charges,,,33.6,,3.02,3.02,175.39,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,3.02,3.02,211.68,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,24.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,23.5,23.5,23.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9,9,10.26,51,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.92,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,11.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.53,448,,facility
URINALYSIS AUTO W/O SCOPE,81003,CPT,307,RC,,,,outpatient,,,4,0.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,2,2,2,141,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,148.09,148.09,148.09,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,143.32,15.84,143.32,137,percent of total billed charges,,,33.6,,84.34,9.5,143.32,35,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,84.34,10.08,85.09,61,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,4.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,125.5,125.5,125.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,251,251,251,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,2,2,2,1 through 10,percent of total billed charges,,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,2,2,2,997,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.85,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,2.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,2.25,448,,facility
ASSAY OF PARATHORMONE,83970,CPT,301,RC,,,,outpatient,,,112.5,11.25,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,36.72,36.72,36.72,87,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,67.85,67.85,67.85,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,41.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,41.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,60.72,38.64,209.62,23,percent of total billed charges,,,33.6,,38.64,38.64,38.64,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,38.99,38.64,134.58,39,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,41.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,86.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,43.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,83.37,83.37,83.37,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,36.72,36.72,36.72,244,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,41.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,43.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,89.18,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,42.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,41.28,448,,facility
CCP ANTIBODY,86200,CPT,302,RC,,,,outpatient,,,90,9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.52,11.52,11.52,14,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,70.8,70.8,70.8,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,63.36,25.87,63.36,1 through 10,percent of total billed charges,,,33.6,,40.32,40.32,63.36,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,33.26,16.46,40.68,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.52,11.52,11.52,56,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.97,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.95,448,,facility
NUCLEAR ANTIGEN ANTIBODY,86235,CPT,302,RC,,,,outpatient,,,25,2.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13,12.5,15.95,11,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,54.91,4.37,90.29,43,percent of total billed charges,,,33.6,,4.37,4.37,53.09,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,22.18,4.24,83.33,13,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,37.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.95,13,15.95,54,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.75,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.93,448,,facility
STIMULANTS SYNTHETIC,80371,CPT,301,RC,,,,outpatient,,,40,4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
HEMOGLOBIN GLYCOSYLATED A1C,83036,CPT,301,RC,,,,outpatient,,,11,1.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,8.64,8.64,8.64,577,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,34.22,33.93,128.62,24,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,30.62,19.49,115.1,181,percent of total billed charges,,,33.6,,19.49,19.49,73.25,32,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,19.49,19.49,19.49,332,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,9.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,20.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,29,28.75,29,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,12.18,12.08,45.78,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,8.64,8.64,8.64,1 through 10,percent of total billed charges,,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,8.64,8.64,8.64,1281,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,9.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.98,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,9.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,9.71,448,,facility
IMMUNOASSAY TUMOR OTHER,86316,CPT,302,RC,,,,outpatient,,,57,5.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,18.51,18.51,18.51,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,76.03,32.21,76.03,1 through 10,percent of total billed charges,,,33.6,,48.38,48.38,48.38,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,20.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,43.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,18.51,18.51,18.51,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,20.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,44.98,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,21.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,20.81,448,,facility
FACTOR INHIBITOR TEST,85335,CPT,305,RC,,,,outpatient,,,310,31,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.45,11.45,11.45,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,598.85,598.85,598.85,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,26.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.45,11.45,11.45,14,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.81,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.87,448,,facility
MITOCHONDRIAL ANTIBODY EACH,86381,CPT,302,RC,,,,outpatient,,,25,2.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,22.64,22.64,22.64,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,45.41,16.13,249.13,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,28.9,28.9,28.9,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,25.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,53.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,26.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,22.64,22.64,22.64,19,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,25.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,26.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,44.54,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,25.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,25.45,448,,facility
HPV HI-RISK TYP POOLED RSLT,87624,CPT,306,RC,,,,outpatient,,,178,17.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,51,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,57.23,57.23,57.23,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,85.34,51.22,134.11,1 through 10,percent of total billed charges,,,33.6,,32.59,32.59,85.34,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,85.34,75.94,85.34,14,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,112,48.5,112,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,20.37,20.37,53.34,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,80,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
LACTATE (LD) (LDH) ENZYME,83615,CPT,301,RC,,,,outpatient,,,7,0.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.37,5.37,5.37,60,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,38.94,38.94,38.94,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,34.85,11.09,34.85,38,percent of total billed charges,,,33.6,,22.18,22.18,22.18,46,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,20.95,20.95,22.18,22,percent of total billed charges,,,34.6,,23.96,20.95,25.15,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,12.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,13.86,13.86,13.86,17,percent of total billed charges,,,35,,27.5,27.5,27.5,1 through 10,percent of total billed charges,,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.37,5.37,5.37,235,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.04,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,6.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,6.04,448,,facility
CMV ANTIBODY,86644,CPT,302,RC,,,,outpatient,,,102,10.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.8,12.8,12.8,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,30.08,30.08,85.12,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,70.22,44.69,76.56,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,49.24,48.72,49.24,1 through 10,percent of total billed charges,,,34.6,,48.28,17.91,50.67,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,30.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.8,12.8,12.8,11,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,31.1,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.39,448,,facility
ASSAY OF THYROGLOBULIN,84432,CPT,301,RC,,,,outpatient,,,108,10.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,14.29,14.29,14.29,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,5.9,5.9,33.04,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,5.28,3.36,29.57,1 through 10,percent of total billed charges,,,33.6,,14.58,14.58,18.82,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,14.58,3.36,18.82,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,33.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,14.29,10,14.29,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,34.7,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,16.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,16.06,448,,facility
ASSAY OF NUCLEOTIDASE,83915,CPT,301,RC,,,,outpatient,,,44.5,4.45,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,23.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.1,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,11.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.15,448,,facility
SPECIMEN INFECT AGNT CONCNTJ,87015,CPT,306,RC,,,,outpatient,,,25,2.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.94,5.94,5.94,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,13.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,7.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.94,5.94,5.94,23,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,7.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.42,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,6.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,6.68,448,,facility
IMMUNOASSAY NONANTIBODY,83516,CPT,301,RC,,,,outpatient,,,112.5,11.25,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9,9,10.26,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,4.75,4.75,218.59,30,percent of total billed charges,,,33.6,,3.02,3.02,175.39,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,3.02,3.02,211.68,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,24.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,23.5,23.5,23.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9,9,10.26,51,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.92,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,11.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.53,448,,facility
RIA NONANTIBODY,83519,CPT,301,RC,,,,outpatient,,,159,15.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,55.44,55.44,55.44,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.37,16.37,16.37,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.2,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.4,448,,facility
HBA1/HBA2 GENE DUP/DEL VRNTS,81269,CPT,310,RC,,,,outpatient,,,1127,112.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,180.03,180.03,180.03,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,202.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,202.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,208.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,292.99,292.99,292.99,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,202.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,423.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,214.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,202.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,214.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,354.2,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,206.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,202.4,448,,facility
BCR/ABL1 GENE MINOR BP,81207,CPT,310,RC,,,,outpatient,,,375,37.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,144.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,144.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,149.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,144.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,302.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,153.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,144.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,153.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,312.92,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,147.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,144.84,448,,facility
ASSAY OF FERRITIN,82728,CPT,301,RC,,,,outpatient,,,302,30.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.12,12.12,12.12,348,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,56.64,56.64,185.26,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,50.69,32.26,165.79,96,percent of total billed charges,,,33.6,,32.26,32.26,165.79,18,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,32.26,32.26,105.5,115,percent of total billed charges,,,34.6,,116.18,116.18,116.18,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,28.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,48,48,48,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,65.94,20.16,65.94,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.12,12.12,12.12,882,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.45,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.63,448,,facility
ASSAY AMINOLEVULINIC ACID,82135,CPT,301,RC,,,,outpatient,,,42.25,4.23,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,14.63,14.63,14.63,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,34.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.54,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,16.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,16.45,448,,facility
FETAL CHRMOML MICRODELTJ,81422,CPT,310,RC,,,,outpatient,,,621,62.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,759.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,759.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,781.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,759.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1586.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,804.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,759.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,804.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1328.34,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,774.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1586.41,,facility
SKIN FUNGI CULTURE,87101,CPT,306,RC,,,,outpatient,,,25,2.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,6.86,6.86,6.86,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,43.66,43.66,43.66,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,206.98,206.98,206.98,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,7.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,16.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,6.86,6.86,6.86,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,7.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.64,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,7.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,7.71,448,,facility
KETONE BODYS QUAN,82010,CPT,301,RC,,,,outpatient,,,12,1.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,7.27,7.27,7.27,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,59.66,59.14,100.5,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,17.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,7.27,7.27,7.27,32,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.66,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,8.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,8.17,448,,facility
ASSAY OF URINE/URIC ACID,84560,CPT,301,RC,,,,outpatient,,,37,3.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.52,4.52,4.52,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,10.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.26,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.08,448,,facility
OCCULT BLOOD OTHER SOURCES,82271,CPT,301,RC,,,,outpatient,,,6.82,0.68,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,11.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.73,4.73,4.73,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.31,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.32,448,,facility
HEMOGLOBIN CHROMOTOGRAPHY,83021,CPT,301,RC,,,,outpatient,,,392,39.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.06,16.06,16.06,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,37.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,58.38,58.38,58.38,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.06,16.06,16.06,16,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,39.01,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.06,448,,facility
AGENT NOS ASSAY W/OPTIC,87899,CPT,306,RC,,,,outpatient,,,25,2.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,33.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,14.29,14.29,14.29,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.12,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,16.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,16.07,448,,facility
ASSAY OF TRANSFERRIN,84466,CPT,301,RC,,,,outpatient,,,37.41,3.74,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.35,11.35,11.35,19,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,63.57,63.57,63.57,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,57.02,36.29,217.54,41,percent of total billed charges,,,33.6,,36.29,36.29,217.54,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,36.53,36.29,138.43,42,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,26.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,54,53.88,54,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.35,11.35,11.35,63,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.58,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.76,448,,facility
ASSAY LIPOPROTEIN PLA2,83698,CPT,301,RC,,,,outpatient,,,47,4.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,46.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,46.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,47.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,46.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,96.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,49.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,46.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,49.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,81.04,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,47.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,46.31,448,,facility
HIV-1 QUANT&REVRSE TRNSCRPJ,87536,CPT,306,RC,,,,outpatient,,,146,14.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,75.7,75.7,75.7,61,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,115.05,115.05,369.93,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,124.8,124.8,124.8,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,85.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,85.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,87.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,102.96,65.52,102.96,24,percent of total billed charges,,,33.6,,102.96,65.52,331.06,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,65.52,65.52,66.11,15,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,85.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,177.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,90.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,97.5,97.5,97.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,75.7,75.7,75.7,201,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,85.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,90.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,183.86,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,86.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,85.1,448,,facility
IMMUNOASSAY QUANT NOS NONAB,83520,CPT,301,RC,,,,outpatient,,,78.3,7.83,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,36,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,66.08,66.08,66.08,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,41.18,24.82,318.38,1 through 10,percent of total billed charges,,,33.6,,37.63,37.63,96.43,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,33.6,23.18,176.4,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,36.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,87,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.22,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.27,448,,facility
PHENOTYPE DNA HIV W/CULTURE,87903,CPT,306,RC,,,,outpatient,,,723.6,72.36,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,488.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,488.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,503.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,488.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1021.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,517.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,488.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,517.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1055.74,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,498.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1055.74,,facility
BLOOD TYPING RBC ANTIGENS,86905,CPT,302,RC,,,,outpatient,,,27.75,2.78,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,316.43,315.62,343.05,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,343.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,343.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,353.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,343.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,716.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,363.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.41,3.41,13.64,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,343.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,363.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.28,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,349.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,8.28,716.97,,facility
DEOXYCORTISOL,82634,CPT,301,RC,,,,outpatient,,,68.45,6.85,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,29.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,61.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,31.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,29.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,31.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,63.25,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,29.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,29.28,448,,facility
ENZYME CELL ACTIVITY,82657,CPT,301,RC,,,,outpatient,,,126.3,12.63,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.72,19.72,19.72,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,2094.14,2094.14,2094.14,1 through 10,percent of total billed charges,,,33.6,,762.96,762.96,762.96,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,46.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,23.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.72,19.72,19.72,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,23.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,39.01,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,22.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,22.17,448,,facility
NFCT AGT GNTYP ALYS HIV1 REV,87901,CPT,306,RC,,,,outpatient,,,250,25,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,295,295,295,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,257.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,257.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,265.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,264,264,264,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,257.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,538.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,272.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,229,229,229,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,257.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,272.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,556.22,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,262.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,257.45,556.22,,facility
EPSTEIN-BARR ANTIBODY,86663,CPT,302,RC,,,,outpatient,,,42,4.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.35,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.12,448,,facility
IMMUNOASSAY QUANT NOS NONAB,83520,CPT,301,RC,,,,outpatient,,,107,10.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,36,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,66.08,66.08,66.08,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,41.18,24.82,318.38,1 through 10,percent of total billed charges,,,33.6,,37.63,37.63,96.43,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,33.6,23.18,176.4,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,36.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,87,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.22,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.27,448,,facility
MOPATH PROCEDURE LEVEL 7,81406,CPT,310,RC,,,,outpatient,,,1062,106.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,282.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,282.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,291.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,282.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,591.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,299.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,282.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,299.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,495.04,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,288.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,282.88,591.22,,facility
HEMOGLOBIN CHROMOTOGRAPHY,83021,CPT,301,RC,,,,outpatient,,,170,17,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.06,16.06,16.06,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,37.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,58.38,58.38,58.38,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.06,16.06,16.06,16,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,39.01,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.06,448,,facility
HEMOGLOBIN FETAL,85460,CPT,305,RC,,,,outpatient,,,26,2.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,7.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,16.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,6.88,6.88,6.88,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,7.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.71,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,7.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,7.73,448,,facility
COL CHROMOTOGRAPHY QUAL/QUAN,82542,CPT,301,RC,,,,outpatient,,,99,9.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,21.43,21.43,21.43,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,435.07,435.07,435.07,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,24.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,50.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,25.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,21.43,21.43,21.43,15,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,24.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,25.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.16,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,24.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,24.09,448,,facility
MOPATH PROCEDURE LEVEL 6,81405,CPT,310,RC,,,,outpatient,,,770,77,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,301.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,301.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,310.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,301.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,629.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,319.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,301.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,319.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,527.36,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,307.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,301.35,629.82,,facility
DRUG SCREENING TAPENTADOL,80372,CPT,301,RC,,,,outpatient,,,35,3.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
ASSAY ALKALINE PHOSPHATASES,84080,CPT,301,RC,,,,outpatient,,,25,2.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.15,13.15,13.15,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,12.43,12.43,12.43,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,12.43,12.43,12.54,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,30.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.15,13.15,13.15,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,31.94,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,15.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.78,448,,facility
LIPOPRO BLD ELECTROPHORETIC,83700,CPT,301,RC,,,,outpatient,,,26.1,2.61,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,23.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.33,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,11.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.26,448,,facility
ENTEROVIRUS ANTIBODY,86658,CPT,302,RC,,,,outpatient,,,9.41,0.94,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.14,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.03,448,,facility
HEAVY METAL QUAN EACH NES,83018,CPT,301,RC,,,,outpatient,,,35.1,3.51,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,21.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,45.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,23.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,21.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,23.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,47.46,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,22.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,21.96,448,,facility
SC STD DISK METHOD PER PLATE,87184,CPT,306,RC,,,,outpatient,,,8,0.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,7.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,15.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,7.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,6.65,6.65,6.65,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,7.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,7.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.89,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,7.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,7.48,448,,facility
IMMUNOASSAY QUANT NOS NONAB,83520,CPT,301,RC,,,,outpatient,,,395,39.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,36,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,66.08,66.08,66.08,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,41.18,24.82,318.38,1 through 10,percent of total billed charges,,,33.6,,37.63,37.63,96.43,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,33.6,23.18,176.4,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,36.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,87,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.22,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.27,448,,facility
CHEMILUMINESCENT ASSAY,82397,CPT,301,RC,,,,outpatient,,,194,19.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.56,12.56,12.56,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,22.85,22.85,22.85,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,29.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.56,12.56,12.56,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.5,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.12,448,,facility
RIA NONANTIBODY,83519,CPT,301,RC,,,,outpatient,,,1055,105.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,55.44,55.44,55.44,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.37,16.37,16.37,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.2,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.4,448,,facility
ASSAY OF CREATINE,82540,CPT,301,RC,,,,outpatient,,,31.75,3.18,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,9.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.01,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,4.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,4.64,448,,facility
ASSAY NONENDOCRINE RECEPTOR,84238,CPT,301,RC,,,,outpatient,,,68.65,6.87,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,37.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,36.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,76.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,38.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,36.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,38.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,79,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,37.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,36.57,448,,facility
ENCEPHALTIS EAST EQNE ANBDY,86652,CPT,302,RC,,,,outpatient,,,80,8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.49,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.19,448,,facility
QUANTITATIVE ASSAY DRUG,80299,CPT,301,RC,,,,outpatient,,,310,31,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,13,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,174.64,174.64,174.64,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,171.6,171.6,171.6,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,374.52,374.52,374.52,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.62,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.64,448,,facility
BLOOD PLATELET AGGREGATION,85576,CPT,305,RC,,,,outpatient,,,97.5,9.75,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,22.16,22.16,22.16,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,70.56,70.56,70.56,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,24.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,52.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,26.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,22.16,22.16,22.16,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,24.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,26.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,46.41,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,25.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,24.91,448,,facility
ASY HYDROXYPROGESTERONE 17-D,83498,CPT,301,RC,,,,outpatient,,,59.1,5.91,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,24.17,24.17,24.17,28,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,27.14,27.14,27.14,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,37.17,36.96,302.02,1 through 10,percent of total billed charges,,,33.6,,23.52,23.52,23.52,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,23.52,15.46,96.1,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,27.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,56.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,28.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,24.17,24.17,24.17,45,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,27.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,28.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,58.7,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,27.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,27.17,448,,facility
NUCLEAR ANTIGEN ANTIBODY,86235,CPT,302,RC,,,,outpatient,,,115,11.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13,12.5,15.95,11,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,54.91,4.37,90.29,43,percent of total billed charges,,,33.6,,4.37,4.37,53.09,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,22.18,4.24,83.33,13,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,37.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.95,13,15.95,54,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.75,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.93,448,,facility
AMINO ACIDS QUAN 6 OR MORE,82139,CPT,301,RC,,,,outpatient,,,168.75,16.88,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.01,12,15.01,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,230.18,110.21,262.42,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,35.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,164.01,164.01,164.01,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.01,12,15.01,16,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.45,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,16.87,448,,facility
BETA-2 GLYCOPROTEIN ANTIBODY,86146,CPT,302,RC,,,,outpatient,,,212,21.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,22.64,22.64,22.64,11,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,90.82,24.82,293.57,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,57.79,57.79,186.82,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,25.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,53.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,26.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,128.1,128.1,128.1,1 through 10,percent of total billed charges,,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,22.64,22.64,22.64,25,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,25.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,26.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,54.99,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,25.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,25.45,448,,facility
BLOOD PLATELET AGGREGATION,85576,CPT,305,RC,,,,outpatient,,,150,15,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,22.16,22.16,22.16,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,70.56,70.56,70.56,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,24.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,52.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,26.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,22.16,22.16,22.16,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,24.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,26.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,46.41,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,25.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,24.91,448,,facility
ASSAY OF GASTRIN,82941,CPT,301,RC,,,,outpatient,,,31.3,3.13,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,36.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.68,15.68,15.68,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.1,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.63,448,,facility
COL CHROMOTOGRAPHY QUAL/QUAN,82542,CPT,301,RC,,,,outpatient,,,273,27.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,21.43,21.43,21.43,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,435.07,435.07,435.07,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,24.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,50.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,25.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,21.43,21.43,21.43,15,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,24.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,25.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.16,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,24.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,24.09,448,,facility
LISTERIA MONOCYTOGENES,86723,CPT,302,RC,,,,outpatient,,,108,10.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.49,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.19,448,,facility
ASSAY OF URINE CREATININE,82570,CPT,301,RC,,,,outpatient,,,37,3.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.61,4.61,4.61,213,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,71.39,41.89,142.78,14,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,37.49,23.86,74.98,60,percent of total billed charges,,,33.6,,37.49,23.85,81.31,18,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,24.07,23.86,47.71,75,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,10.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,60.5,4.61,151,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,14.91,14.91,25.41,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,85.58,85.58,85.58,1 through 10,percent of total billed charges,,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.61,4.61,4.61,636,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.18,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.18,448,,facility
HEMOGLOBIN,85018,CPT,305,RC,,,,outpatient,,,33,3.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,2.11,2.11,2.11,20,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,17.92,17.92,72.32,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,3.32,3.32,16.52,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,59.66,14.92,94.03,1 through 10,percent of total billed charges,,,33.6,,14.78,14.78,14.92,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,9.41,9.41,37.97,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,4.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,14,14,14,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,2.11,2.11,2.11,57,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.13,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,2.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,2.37,448,,facility
ASSAY OF GONADOTROPIN (FSH),83001,CPT,301,RC,,,,outpatient,,,16,1.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.53,16.53,16.53,63,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,146.91,146.91,146.91,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,35.38,22.51,35.38,22,percent of total billed charges,,,33.6,,35.38,35.38,131.47,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,22.51,22.51,83.66,27,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,33.5,33.5,33.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,14.07,14.07,14.07,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.53,16.53,16.53,116,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,40.15,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.58,448,,facility
TRICHOMONAS VAGINALIS AMPLIF,87661,CPT,306,RC,,,,outpatient,,,149,14.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,57,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,127.44,127.44,127.44,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,114.05,72.58,123.34,1 through 10,percent of total billed charges,,,33.6,,28.9,28.9,114.05,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,72.58,28.9,73.22,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,91,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
IMMUNOASSAY QUANT NOS NONAB,83520,CPT,301,RC,,,,outpatient,,,109.1,10.91,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,36,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,66.08,66.08,66.08,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,41.18,24.82,318.38,1 through 10,percent of total billed charges,,,33.6,,37.63,37.63,96.43,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,33.6,23.18,176.4,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,36.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,87,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.22,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.27,448,,facility
CARCINOEMBRYONIC ANTIGEN,82378,CPT,301,RC,,,,outpatient,,,42,4.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.86,16.86,16.86,25,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,89.04,28.9,139.92,41,percent of total billed charges,,,33.6,,89.04,28.9,89.04,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,28.9,28.9,89.04,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,39.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,20.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,132.5,132.5,132.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.86,16.86,16.86,36,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,20.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,40.97,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.96,448,,facility
ASSAY NEPHELOMETRY NOT SPEC,83883,CPT,301,RC,,,,outpatient,,,67.5,6.75,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.1,12.1,12.1,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,173.18,51.22,173.18,1 through 10,percent of total billed charges,,,33.6,,31.58,31.58,31.58,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,31.58,31.53,110.21,11,percent of total billed charges,,,34.6,,119.06,117.35,124.97,24,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,28.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.1,12.1,12.1,29,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.38,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.6,448,,facility
ISLET CELL ANTIBODY,86341,CPT,302,RC,,,,outpatient,,,255,25.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,20.97,20.97,20.97,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,23.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,23.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,143.62,143.62,326.83,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,258.38,258.38,258.38,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,23.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,49.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,24.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,20.97,20.97,20.97,14,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,23.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,24.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.75,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,24.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,23.57,448,,facility
HEAVY METAL QUAN EACH NES,83018,CPT,301,RC,,,,outpatient,,,63,6.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,21.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,45.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,23.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,21.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,23.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,47.46,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,22.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,21.96,448,,facility
URINALYSIS NONAUTO W/O SCOPE,81002,CPT,307,RC,,,,outpatient,,,10.71,1.07,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.1,3.1,3.1,63,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,7.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.1,3.1,3.1,277,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.09,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,3.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,3.48,448,,facility
MOPATH PROCEDURE LEVEL 1,81400,CPT,310,RC,,,,outpatient,,,588,58.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,63.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,63.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,65.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,63.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,133.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,67.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,63.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,67.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,111.93,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,65.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,63.96,448,,facility
MOPATH PROCEDURE LEVEL 7,81406,CPT,310,RC,,,,outpatient,,,344,34.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,282.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,282.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,291.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,282.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,591.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,299.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,282.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,299.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,495.04,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,288.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,282.88,591.22,,facility
SEDATIVE HYPNOTICS,80368,CPT,301,RC,,,,outpatient,,,63,6.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
TOXOPLASMA ANTIBODY,86777,CPT,302,RC,,,,outpatient,,,30.75,3.08,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.8,12.8,12.8,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,64.42,64.42,64.42,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,30.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.8,12.8,12.8,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,31.1,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.39,448,,facility
PROTOZOA ANTIBODY NOS,86753,CPT,302,RC,,,,outpatient,,,112.5,11.25,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.02,11.02,11.02,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,98.11,98.11,154.18,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,96.77,32.38,106,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.02,11.02,11.02,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.76,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.39,448,,facility
BILIRUBIN TOTAL,82247,CPT,301,RC,,,,outpatient,,,4,0.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.47,4.47,4.47,72,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,19.47,19.47,221.84,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,376,376,376,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,214.7,17.42,214.7,80,percent of total billed charges,,,33.6,,126.34,11.09,198.53,22,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,126.34,11.09,127.46,57,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,10.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,16.5,16.5,188,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,6.93,6.93,6.93,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.47,4.47,4.47,682,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.02,448,,facility
ASSAY ANTI-MULLERIAN HORM,82166,CPT,301,RC,,,,outpatient,,,65,6.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,39.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,98.74,98.74,118.27,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,62.83,62.83,63.39,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,38.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,80.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,40.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,93.5,93.5,93.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,38.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,40.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,67.59,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,39.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,38.62,448,,facility
PNEUMOCYSTIS CARINII AG IF,87281,CPT,306,RC,,,,outpatient,,,29.55,2.96,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.66,10.66,10.66,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.9,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.98,448,,facility
HEPATITIS B DNA QUANT,87517,CPT,306,RC,,,,outpatient,,,135,13.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,38.11,38.11,38.11,15,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,44.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,95.04,95.04,355.34,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,60.48,60.48,95.09,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,89.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,45.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,90,90,90,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,38.11,38.11,38.11,25,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,45.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,92.54,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,43.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,42.84,448,,facility
COL CHROMOTOGRAPHY QUAL/QUAN,82542,CPT,301,RC,,,,outpatient,,,375,37.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,21.43,21.43,21.43,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,435.07,435.07,435.07,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,24.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,50.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,25.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,21.43,21.43,21.43,15,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,24.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,25.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.16,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,24.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,24.09,448,,facility
MOPATH PROCEDURE LEVEL 5,81404,CPT,310,RC,,,,outpatient,,,430,43,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,274.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,274.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,283.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,274.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,574.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,291.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,274.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,291.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,480.95,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,280.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,274.83,574.39,,facility
QUANTITATIVE ASSAY DRUG,80299,CPT,301,RC,,,,outpatient,,,69,6.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,13,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,174.64,174.64,174.64,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,171.6,171.6,171.6,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,374.52,374.52,374.52,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.62,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.64,448,,facility
ENCEPHALTIS ST LOUIS ANTBODY,86653,CPT,302,RC,,,,outpatient,,,43,4.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.49,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.19,448,,facility
BETA-2 GLYCOPROTEIN ANTIBODY,86146,CPT,302,RC,,,,outpatient,,,201,20.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,22.64,22.64,22.64,11,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,90.82,24.82,293.57,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,57.79,57.79,186.82,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,25.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,53.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,26.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,128.1,128.1,128.1,1 through 10,percent of total billed charges,,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,22.64,22.64,22.64,25,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,25.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,26.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,54.99,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,25.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,25.45,448,,facility
ANTIDEPRESSANT NOT SPECIFIED,80338,CPT,301,RC,,,,outpatient,,,40,4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
IGG 1 2 3 OR 4 EACH,82787,CPT,301,RC,,,,outpatient,,,17.6,1.76,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,52.8,13.2,263.18,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,33.9,33.9,33.9,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,16.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.33,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,8.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,8.02,448,,facility
STOOL CULTR AEROBIC BACT EA,87046,CPT,306,RC,,,,outpatient,,,13,1.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,62.83,62.83,62.83,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,9.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,19.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,9.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.41,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,9.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,9.44,448,,facility
TOXOPLASMA ANTIBODY IGM,86778,CPT,302,RC,,,,outpatient,,,30.75,3.08,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.82,12.82,12.82,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,30.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.82,12.82,12.82,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,31.12,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.41,448,,facility
ASSAY OF MAGNESIUM,83735,CPT,301,RC,,,,outpatient,,,39.55,3.96,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.96,5.96,5.96,292,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,9.38,5.96,25.37,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,197.47,22.7,213.55,144,percent of total billed charges,,,33.6,,125.66,125.66,126.79,59,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,125.66,14.45,142.49,154,percent of total billed charges,,,34.6,,135.76,135.76,142.49,1 through 10,percent of total billed charges,,,45,,5.96,5.96,5.96,1 through 10,percent of total billed charges,,6.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,7.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,21.5,21.5,187,13,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,78.54,78.54,78.54,21,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.96,5.96,5.96,1555,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,7.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.47,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,6.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,6.7,448,,facility
QUANTITATIVE ASSAY DRUG,80299,CPT,301,RC,,,,outpatient,,,157.5,15.75,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,13,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,174.64,174.64,174.64,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,171.6,171.6,171.6,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,374.52,374.52,374.52,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.62,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.64,448,,facility
BETA-2 GLYCOPROTEIN ANTIBODY,86146,CPT,302,RC,,,,outpatient,,,64,6.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,22.64,22.64,22.64,11,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,90.82,24.82,293.57,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,57.79,57.79,186.82,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,25.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,53.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,26.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,128.1,128.1,128.1,1 through 10,percent of total billed charges,,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,22.64,22.64,22.64,25,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,25.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,26.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,54.99,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,25.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,25.45,448,,facility
TISS TRNSGLTMNASE EA IG CLAS,86364,CPT,302,RC,,,,outpatient,,,46,4.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9,9,10.26,36,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,10.62,10.62,55.46,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,9.5,6.1,38.02,36,percent of total billed charges,,,33.6,,6.05,6.05,6.05,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,6.05,6.05,6.1,19,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,24.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,9,9,9,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9,9,10.26,141,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.18,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,11.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.53,448,,facility
CELL FUNCTION ASSAY W/STIM,86352,CPT,302,RC,,,,outpatient,,,316.5,31.65,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,135.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,135.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,139.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,210.52,210.52,210.52,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,135.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,283.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,144.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,120.85,120.85,120.85,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,135.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,144.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,293.53,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,138.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,135.86,448,,facility
DGP ANTIBODY EACH IG CLASS,86258,CPT,302,RC,,,,outpatient,,,32,3.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.72,10.72,10.72,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,10.62,10.62,10.62,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,31.58,6.1,49.63,18,percent of total billed charges,,,33.6,,6.05,6.05,6.05,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,6.05,6.05,6.1,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,9,9,9,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.72,10.72,10.72,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.18,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.05,448,,facility
DRUG ASSAY ADALIMUMAB,80145,CPT,301,RC,,,,outpatient,,,371,37.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,39.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,38.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,80.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,40.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,34.31,34.31,34.31,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,38.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,40.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,67.5,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,39.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,38.57,448,,facility
M.TUBERCULO DNA AMP PROBE,87556,CPT,306,RC,,,,outpatient,,,373,37.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,41.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,41.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,41.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,87.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,44.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,41.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,44.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,42.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,41.68,448,,facility
ANALGESICS NON-OPIOID 6/MORE,80331,CPT,301,RC,,,,outpatient,,,40,4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
HPA-1 GENOTYPING,81105,CPT,310,RC,,,,outpatient,,,210,21,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,122.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,122.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,125.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,122.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,255.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,129.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,122.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,129.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,264.06,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,124.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,122.22,448,,facility
CHROMOGENIC SUBSTRATE ASSAY,85130,CPT,305,RC,,,,outpatient,,,150,15,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.58,10.58,10.58,11,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,571.12,571.12,571.12,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,277.2,277.2,277.2,1 through 10,percent of total billed charges,,,33.6,,176.4,176.4,176.4,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,24.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.58,10.58,10.58,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.69,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.89,448,,facility
QUANTITATIVE ASSAY DRUG,80299,CPT,301,RC,,,,outpatient,,,96,9.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,13,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,174.64,174.64,174.64,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,171.6,171.6,171.6,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,374.52,374.52,374.52,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.62,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.64,448,,facility
IMMUNODIFFUSION NES,86329,CPT,302,RC,,,,outpatient,,,47.5,4.75,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,29.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.35,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.05,448,,facility
FUNGUS ISOLATION CULTURE,87102,CPT,306,RC,,,,outpatient,,,13,1.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,7.48,7.48,7.48,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,206.98,206.98,325.25,1 through 10,percent of total billed charges,,,33.6,,206.98,206.98,206.98,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,206.98,206.98,206.98,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,17.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,7.48,7.48,7.48,47,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.17,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,8.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,8.41,448,,facility
THYROGLOBULIN ANTIBODY,86800,CPT,302,RC,,,,outpatient,,,33.1,3.31,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,14.15,14.15,14.15,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,19.47,19.47,92.63,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,17.42,11.09,82.9,1 through 10,percent of total billed charges,,,33.6,,41.02,41.02,52.75,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,41.02,11.09,52.75,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,33.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,14.15,14.15,14.15,30,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,34.37,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,16.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,15.91,448,,facility
VIRUS ANTIBODY NOS,86790,CPT,302,RC,,,,outpatient,,,51.75,5.18,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.46,11.46,11.46,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,107.86,20.06,169.49,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,116.52,40.29,122.3,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,26.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.46,11.46,11.46,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.88,448,,facility
VARICELLA ZOSTER AG IF,87290,CPT,306,RC,,,,outpatient,,,15,1.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,28.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.9,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.42,448,,facility
WBC ANTIBODY IDENTIFICATION,86021,CPT,302,RC,,,,outpatient,,,32.5,3.25,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.39,13.39,13.39,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,20.59,13.1,38.54,1 through 10,percent of total billed charges,,,33.6,,134.11,134.11,134.11,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,13.1,13.1,13.1,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,31.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.39,13.39,13.39,23,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.53,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,15.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,15.05,448,,facility
DRUG TEST DEF SIMPLE ALL CL,G0659,HCPCS,300,RC,,,,outpatient,,,218.75,21.88,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,221.44,184.32,221.44,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,62.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,62.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,171.87,96.77,197.57,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,116.26,102.04,116.26,15,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,62.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,129.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,65.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,144,144,173,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,72.66,72.66,72.66,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,62.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,65.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,125.7,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,63.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,62.14,448,,facility
ASSAY OF BIOTINIDASE,82261,CPT,301,RC,,,,outpatient,,,96.5,9.65,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.01,15.01,15.01,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,35.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.01,15.01,15.01,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.45,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,16.87,448,,facility
ASSAY IGA/IGD/IGG/IGM EACH,82784,CPT,301,RC,,,,outpatient,,,7.5,0.75,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,8.27,8.27,8.27,98,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,114.46,59,343.38,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,52.8,30.49,158.4,64,percent of total billed charges,,,33.6,,19.58,19.49,33.6,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,53.09,19.49,195.55,67,percent of total billed charges,,,34.6,,190.57,73.91,336.04,67,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,9.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,19.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,9.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,29,29,50,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,8.27,8.27,8.27,371,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,9.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,9.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.09,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,9.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,9.3,448,,facility
CHEMILUMINESCENT ASSAY,82397,CPT,301,RC,,,,outpatient,,,284,28.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.56,12.56,12.56,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,22.85,22.85,22.85,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,29.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.56,12.56,12.56,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.5,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.12,448,,facility
CHLMYD TRACH DNA AMP PROBE,87491,CPT,306,RC,,,,outpatient,,,35,3.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,442,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,20.65,20.65,65.49,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,232.32,232.32,232.32,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,37.3,18.48,58.61,62,percent of total billed charges,,,33.6,,37.3,11.76,63.38,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,28.82,11.76,37.3,69,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,42.5,17.5,55.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,23.31,23.31,23.31,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,31.21,31.21,31.21,1 through 10,percent of total billed charges,,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,796,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
DETECT AGENT NOS DNA AMP,87798,CPT,306,RC,,,,outpatient,,,167,16.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,110.88,110.88,174.24,1 through 10,percent of total billed charges,,,33.6,,244.27,244.27,244.27,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,96.77,32.38,119.79,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,38.9,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
HEPATITIS BE ANTIBODY,86707,CPT,302,RC,,,,outpatient,,,19.3,1.93,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.29,10.29,10.29,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,19.14,19.14,19.14,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,12.1,12.1,12.29,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,24.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.29,10.29,10.29,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.99,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,11.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.57,448,,facility
VIT D 1 25-DIHYDROXY,82652,CPT,301,RC,,,,outpatient,,,56.5,5.65,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,34.25,34.25,34.25,16,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,30.68,30.68,30.68,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,39.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,41.71,17.47,46.99,1 through 10,percent of total billed charges,,,33.6,,17.47,17.47,29.9,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,26.78,26.54,26.78,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,38.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,80.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,40.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,39.5,39.5,39.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,34.25,34.25,34.25,35,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,38.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,40.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.18,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,39.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,38.5,448,,facility
CYP2D6 GENE COM VARIANTS,81226,CPT,310,RC,,,,outpatient,,,400,40,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,450.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,450.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,464.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,450.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,942.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,477.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,450.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,477.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,789.09,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,459.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,942.4,,facility
ENTEROVIRUS ANTIBODY,86658,CPT,302,RC,,,,outpatient,,,22,2.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.14,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.03,448,,facility
ZIKA VIRUS IGM ANTIBODY,86794,CPT,302,RC,,,,outpatient,,,222,22.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,35.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.4,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,16.85,448,,facility
IMMUNOASSAY TUMOR CA 19-9,86301,CPT,302,RC,,,,outpatient,,,61,6.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,18.51,18.51,18.51,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,128.41,40.13,163.31,1 through 10,percent of total billed charges,,,33.6,,96.1,96.1,96.1,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,96.1,25.54,96.95,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,20.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,43.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,60.06,60.06,60.06,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,18.51,18.51,18.51,16,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,20.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,44.98,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,21.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,20.81,448,,facility
IGG 1 2 3 OR 4 EACH,82787,CPT,301,RC,,,,outpatient,,,18.7,1.87,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,52.8,13.2,263.18,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,33.9,33.9,33.9,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,16.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.33,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,8.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,8.02,448,,facility
UNLISTED MOLECULAR PATHOLOGY,81479,CPT,310,RC,,,,outpatient,,,925,92.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,561.56,561.56,561.56,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,32.5,32.5,3071.5,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
QUANTITATIVE ASSAY DRUG,80299,CPT,301,RC,,,,outpatient,,,275,27.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,13,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,174.64,174.64,174.64,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,171.6,171.6,171.6,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,374.52,374.52,374.52,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.62,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.64,448,,facility
NUCLEAR ANTIGEN ANTIBODY,86235,CPT,302,RC,,,,outpatient,,,44.8,4.48,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13,12.5,15.95,11,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,54.91,4.37,90.29,43,percent of total billed charges,,,33.6,,4.37,4.37,53.09,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,22.18,4.24,83.33,13,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,37.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.95,13,15.95,54,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.75,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.93,448,,facility
DETECT AGENT NOS DNA AMP,87798,CPT,306,RC,,,,outpatient,,,116,11.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,110.88,110.88,174.24,1 through 10,percent of total billed charges,,,33.6,,244.27,244.27,244.27,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,96.77,32.38,119.79,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,38.9,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
HEPATITIS B SURFACE AG IA,87340,CPT,306,RC,,,,outpatient,,,12,1.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9.19,9.19,9.19,137,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,51.92,51.92,51.92,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,46.46,29.57,140.35,57,percent of total billed charges,,,33.6,,46.46,29.57,46.46,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,29.57,29.57,29.92,75,percent of total billed charges,,,34.6,,34.67,12.1,42.83,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,21.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,44,44,44.13,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,9.19,9.19,9.19,1 through 10,percent of total billed charges,,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9.19,9.19,9.19,421,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.31,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,10.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,10.33,448,,facility
CLOT FACTOR VII PROCONVERTIN,85230,CPT,305,RC,,,,outpatient,,,315,31.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.92,15.92,15.92,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,37.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.92,15.92,15.92,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.68,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.9,448,,facility
CHIMERISM ANAL W/CELL SELECT,81268,CPT,310,RC,,,,outpatient,,,550,55,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,231.97,231.97,231.97,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,2152.96,2152.96,2152.96,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,260.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,260.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,268.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,653.4,653.4,685.8,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,1130.3,495.96,1221.13,22,percent of total billed charges,,,34.6,,1221.13,1221.13,2354.8,12,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,260.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,545.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,276.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,231.97,231.97,231.97,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,260.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,276.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,563.43,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,266.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,260.79,563.43,,facility
STOOL CULTR AEROBIC BACT EA,87046,CPT,306,RC,,,,outpatient,,,15,1.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,62.83,62.83,62.83,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,9.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,19.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,9.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.41,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,9.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,9.44,448,,facility
DRUG SCREENING TRAMADOL,80373,CPT,301,RC,,,,outpatient,,,204,20.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
TOTAL CORTISOL,82533,CPT,301,RC,,,,outpatient,,,49,4.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,14.5,14.5,14.5,28,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,68.44,68.44,68.44,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,203.28,61.25,203.28,34,percent of total billed charges,,,33.6,,203.28,129.36,203.28,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,129.36,29.57,130.52,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,34.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,192.5,58,192.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,14.5,14.5,14.5,104,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.21,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,16.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,16.3,448,,facility
MACROSCOPIC EXAM PARASITE,87169,CPT,306,RC,,,,outpatient,,,35,3.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,9.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.22,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,4.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,4.31,448,,facility
CHLMYD TRACH DNA AMP PROBE,87491,CPT,306,RC,,,,outpatient,,,196,19.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,442,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,20.65,20.65,65.49,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,232.32,232.32,232.32,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,37.3,18.48,58.61,62,percent of total billed charges,,,33.6,,37.3,11.76,63.38,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,28.82,11.76,37.3,69,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,42.5,17.5,55.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,23.31,23.31,23.31,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,31.21,31.21,31.21,1 through 10,percent of total billed charges,,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,796,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
RUBELLA ANTIBODY,86762,CPT,302,RC,,,,outpatient,,,38.5,3.85,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.8,12.8,12.8,18,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,28.32,28.32,28.32,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,25.34,16.13,25.34,14,percent of total billed charges,,,33.6,,16.13,16.13,16.13,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,16.13,16.13,16.27,22,percent of total billed charges,,,34.6,,68.61,68.61,68.61,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,30.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,24,24,44.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,12.8,12.8,12.8,1 through 10,percent of total billed charges,,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.8,12.8,12.8,185,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,31.1,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.39,448,,facility
COAGULATION TIME ACTIVATED,85347,CPT,305,RC,,,,outpatient,,,187,18.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,57.12,38.17,224.4,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,8.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.81,3.81,3.81,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.21,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,4.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,4.28,448,,facility
HLA I & II TYPING LR,81370,CPT,310,RC,,,,outpatient,,,1675,167.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,402.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,402.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,414.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,402.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,840.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,426.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,402.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,426.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,868.79,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,410.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,402.12,868.79,,facility
ASSAY OF THYROGLOBULIN,84432,CPT,301,RC,,,,outpatient,,,157.5,15.75,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,14.29,14.29,14.29,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,5.9,5.9,33.04,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,5.28,3.36,29.57,1 through 10,percent of total billed charges,,,33.6,,14.58,14.58,18.82,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,14.58,3.36,18.82,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,33.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,14.29,10,14.29,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,34.7,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,16.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,16.06,448,,facility
RUSSELL VIPER VENOM DILUTED,85613,CPT,305,RC,,,,outpatient,,,89,8.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,8.52,8.52,8.52,20,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,82.37,20.06,82.37,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,52.42,52.42,52.42,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,9.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,20.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,8.52,8.52,8.52,34,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,9.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.7,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,9.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,9.58,448,,facility
ASSAY OF PREGNENOLONE,84140,CPT,301,RC,,,,outpatient,,,59.1,5.91,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,20.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,43.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,21.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,20.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,21.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,44.66,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,21.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,20.67,448,,facility
ASSAY OF PROGESTERONE,84144,CPT,301,RC,,,,outpatient,,,28,2.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,18.55,18.55,18.55,24,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,41.3,41.3,41.3,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,36.96,23.52,222.29,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,23.52,23.52,141.46,29,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,20.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,43.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,18.55,18.55,18.55,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,20.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,45.08,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,21.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,20.86,448,,facility
UGT1A1 GENE COMMON VARIANTS,81350,CPT,310,RC,,,,outpatient,,,584.3,58.43,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,234,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,234,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,241.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,234,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,489.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,248.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,234,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,248.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,409.5,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,238.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,234,489.06,,facility
ANALGESICS NON-OPIOID 1 OR 2,80329,CPT,301,RC,,,,outpatient,,,27.6,2.76,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
GENETIC TSTG SEVERE INH COND,81443,CPT,310,RC,,,,outpatient,,,4515,451.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2448.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2448.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2522.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2448.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,5117.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2595.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2448.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2595.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4284.98,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,2497.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,5117.49,,facility
ALPHA-FETOPROTEIN SERUM,82105,CPT,301,RC,,,,outpatient,,,16.25,1.63,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,14.92,14.92,14.92,44,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,215.35,215.35,215.35,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,58.61,58.61,192.72,11,percent of total billed charges,,,33.6,,58.61,37.3,122.64,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,37.3,37.3,123.74,15,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,35.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,14.92,14.92,14.92,104,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.24,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,16.77,448,,facility
IMMUNOASSAY NONANTIBODY,83516,CPT,301,RC,,,,outpatient,,,111,11.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9,9,10.26,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,4.75,4.75,218.59,30,percent of total billed charges,,,33.6,,3.02,3.02,175.39,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,3.02,3.02,211.68,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,24.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,23.5,23.5,23.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9,9,10.26,51,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.92,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,11.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.53,448,,facility
ASSAY OF TRIGLYCERIDES,84478,CPT,301,RC,,,,outpatient,,,29.25,2.93,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.11,5.11,5.11,49,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,21.12,13.44,142.03,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,13.44,13.44,13.56,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.11,5.11,5.11,55,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.41,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.74,448,,facility
CLOT FACTOR VIII VW ANTIGEN,85246,CPT,305,RC,,,,outpatient,,,90,9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,20.4,20.4,20.4,44,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,23.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,71.28,45.36,71.28,1 through 10,percent of total billed charges,,,33.6,,45.36,45.36,45.36,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,45.77,45.36,45.77,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,47.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,24.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,67.5,67.5,67.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,20.4,20.4,20.4,74,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,24.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,49.56,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,23.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,22.94,448,,facility
CYTOGENETICS DNA PROBE,88271,CPT,311,RC,,,,outpatient,,,169,16.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.05,19.05,19.05,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,1274.11,1274.11,1274.11,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,477.79,477.79,477.79,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,21.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,44.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.05,19.05,19.05,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,21.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,46.27,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,21.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,21.42,448,,facility
ASSAY OF CHLORAMPHENICOL,82415,CPT,301,RC,,,,outpatient,,,71,7.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,26.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.37,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.67,448,,facility
APPL SHORT LEG CAST,29405,CPT,420,RC,,,,outpatient,,,319.85,31.99,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,80,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,267.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,267.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,275.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,267.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,559.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,283.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,267.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,283.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,422,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,273.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,80,559.45,,facility
AUTOMATED RBC COUNT,85041,CPT,305,RC,,,,outpatient,,,2.19,0.22,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,6.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.53,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,3.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,3.02,448,,facility
IMMUNOASSAY NONANTIBODY,83516,CPT,301,RC,,,,outpatient,,,187.5,18.75,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9,9,10.26,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,4.75,4.75,218.59,30,percent of total billed charges,,,33.6,,3.02,3.02,175.39,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,3.02,3.02,211.68,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,24.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,23.5,23.5,23.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9,9,10.26,51,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.92,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,11.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.53,448,,facility
HISTOPLASMA ANTIBODY,86698,CPT,302,RC,,,,outpatient,,,117,11.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.27,12.27,12.27,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,28.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.27,12.27,12.27,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.79,448,,facility
THROMBOPLASTIN TIME PARTIAL,85730,CPT,305,RC,,,,outpatient,,,42,4.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.35,5.35,5.35,44,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,17.28,17.28,226.56,25,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,208.86,15.93,208.86,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,186.91,11.69,202.13,44,percent of total billed charges,,,33.6,,118.94,9.07,237.89,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,118.94,9.07,120.01,25,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,12.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,177,13.5,177,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.35,5.35,5.35,310,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.99,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,6.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,6.01,448,,facility
WBC ANTIBODY IDENTIFICATION,86021,CPT,302,RC,,,,outpatient,,,56,5.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.39,13.39,13.39,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,20.59,13.1,38.54,1 through 10,percent of total billed charges,,,33.6,,134.11,134.11,134.11,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,13.1,13.1,13.1,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,31.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.39,13.39,13.39,23,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.53,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,15.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,15.05,448,,facility
ADENOVIRUS AG IA,87301,CPT,306,RC,,,,outpatient,,,144,14.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.9,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.98,448,,facility
ANTIDEPRESSANT NOT SPECIFIED,80338,CPT,301,RC,,,,outpatient,,,35,3.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
SO/HL 51/>GSAP DNA/DNA&RNA,81455,CPT,310,RC,,,,outpatient,,,5526,552.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2919.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2919.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3007.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2919.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,6101.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3094.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2919.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3094.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5109.3,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,2977.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,6101.96,,facility
ENZYME CELL ACTIVITY,82657,CPT,301,RC,,,,outpatient,,,341.7,34.17,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.72,19.72,19.72,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,2094.14,2094.14,2094.14,1 through 10,percent of total billed charges,,,33.6,,762.96,762.96,762.96,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,46.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,23.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.72,19.72,19.72,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,23.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,39.01,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,22.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,22.17,448,,facility
ASSAY OF METANEPHRINES,83835,CPT,301,RC,,,,outpatient,,,150,15,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.07,15.07,15.07,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,32.45,32.45,32.45,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,35.28,35.28,35.28,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,35.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.07,15.07,15.07,11,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.61,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,16.94,448,,facility
ASSAY OF SERUM ALBUMIN,82040,CPT,301,RC,,,,outpatient,,,4,0.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.4,4.4,4.4,46,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,14.75,9.9,14.75,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,85,85,85,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,48.53,13.2,48.54,74,percent of total billed charges,,,33.6,,28.56,8.4,48.53,18,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,28.56,8.4,28.82,49,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,10.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,42.5,12.5,42.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,5.25,5.25,5.25,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.4,4.4,4.4,515,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.69,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,4.95,448,,facility
MOPATH PROCEDURE LEVEL 4,81403,CPT,310,RC,,,,outpatient,,,373,37.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,185.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,185.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,190.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,322.39,322.39,322.39,1 through 10,percent of total billed charges,,,34.6,,397.12,397.12,397.12,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,185.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,387.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,196.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,185.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,196.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,324.1,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,188.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,185.2,448,,facility
SPECTROPHOTOMETRY,84311,CPT,301,RC,,,,outpatient,,,25,2.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,7.2,7.2,7.2,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,45.35,45.35,53.33,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,16.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,7.2,7.2,7.2,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.1,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,8.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,8.1,448,,facility
METHYLATION ANALYSIS (SMALL NUCLEAR RIBONUCLEOPROTEIN POLYPEPTIDE N AND UBIQUITIN PROTEIN LIGASE E3A),81331,CPT,0310,RC,,,,outpatient,,,346,34.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,45.43,45.43,45.43,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,51.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,51.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,52.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,51.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,106.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,54.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,51.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,54.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,89.37,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,52.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,51.07,448,,facility
TREPONEMA PALLIDUM,86780,CPT,302,RC,,,,outpatient,,,55,5.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.78,11.78,11.78,612,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,10.62,10.62,50.15,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,9.5,6.05,48.53,46,percent of total billed charges,,,33.6,,6.05,6.05,44.88,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,6.05,6.05,28.56,66,percent of total billed charges,,,34.6,,73.69,20.19,77.34,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,9,9,42.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,17.85,17.85,17.85,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,11.78,11.78,11.78,1 through 10,percent of total billed charges,,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.78,11.78,11.78,550,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.6,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.24,448,,facility
ANTIEPILEPTICS NOS 7/MORE,80341,CPT,301,RC,,,,outpatient,,,35,3.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
MOPATH PROCEDURE LEVEL 7,81406,CPT,310,RC,,,,outpatient,,,2068,206.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,282.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,282.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,291.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,282.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,591.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,299.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,282.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,299.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,495.04,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,288.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,282.88,591.22,,facility
ASSAY THYROID STIM HORMONE,84443,CPT,301,RC,,,,outpatient,,,9.39,0.94,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,14.94,14.94,14.94,707,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,50.15,50.15,279.66,31,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,44.88,28.56,250.27,227,percent of total billed charges,,,33.6,,44.88,28.56,250.27,59,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,28.56,28.56,159.26,382,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,35.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,42.5,42.25,237,16,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,17.85,17.85,99.54,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,14.94,14.94,14.94,1704,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.31,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,16.8,448,,facility
COL CHROMOTOGRAPHY QUAL/QUAN,82542,CPT,301,RC,,,,outpatient,,,178,17.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,21.43,21.43,21.43,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,435.07,435.07,435.07,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,24.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,50.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,25.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,21.43,21.43,21.43,15,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,24.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,25.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.16,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,24.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,24.09,448,,facility
BORDETELLA ANTIBODY,86615,CPT,302,RC,,,,outpatient,,,30.22,3.02,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.73,11.73,11.73,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.49,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.19,448,,facility
TOTAL CORTISOL,82533,CPT,301,RC,,,,outpatient,,,63,6.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,14.5,14.5,14.5,28,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,68.44,68.44,68.44,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,203.28,61.25,203.28,34,percent of total billed charges,,,33.6,,203.28,129.36,203.28,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,129.36,29.57,130.52,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,34.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,192.5,58,192.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,14.5,14.5,14.5,104,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.21,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,16.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,16.3,448,,facility
CLOT FACTOR VII PROCONVERTIN,85230,CPT,305,RC,,,,outpatient,,,76.95,7.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.92,15.92,15.92,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,37.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.92,15.92,15.92,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.68,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.9,448,,facility
DETECT AGENT NOS DNA QUANT,87799,CPT,306,RC,,,,outpatient,,,225,22.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,38.11,38.11,38.11,39,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,44.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,200.64,91.44,597.79,1 through 10,percent of total billed charges,,,33.6,,203.95,203.95,203.95,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,231.27,203.95,231.27,11,percent of total billed charges,,,34.6,,220.34,220.34,231.27,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,89.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,45.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,38.11,38.11,38.11,221,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,45.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,92.54,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,43.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,42.84,448,,facility
ALPHA-FETOPROTEIN AMNIOTIC,82106,CPT,301,RC,,,,outpatient,,,55.25,5.53,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,35.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,212.79,212.79,212.79,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.24,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17,448,,facility
RETICYTE/HGB CONCENTRATE,85046,CPT,305,RC,,,,outpatient,,,56,5.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,11.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.04,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.57,448,,facility
ENZYME CELL ACTIVITY,82657,CPT,301,RC,,,,outpatient,,,136,13.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.72,19.72,19.72,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,2094.14,2094.14,2094.14,1 through 10,percent of total billed charges,,,33.6,,762.96,762.96,762.96,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,46.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,23.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.72,19.72,19.72,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,23.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,39.01,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,22.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,22.17,448,,facility
NUCLEAR ANTIGEN ANTIBODY,86235,CPT,302,RC,,,,outpatient,,,16.5,1.65,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13,12.5,15.95,11,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,54.91,4.37,90.29,43,percent of total billed charges,,,33.6,,4.37,4.37,53.09,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,22.18,4.24,83.33,13,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,37.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.95,13,15.95,54,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.75,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.93,448,,facility
VIRUS ANTIBODY NOS,86790,CPT,302,RC,,,,outpatient,,,30,3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.46,11.46,11.46,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,107.86,20.06,169.49,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,116.52,40.29,122.3,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,26.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.46,11.46,11.46,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.88,448,,facility
ASSAY RBC PROTOPORPHYRIN,84202,CPT,301,RC,,,,outpatient,,,112.5,11.25,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,29.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.99,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.35,448,,facility
ASSAY OF C-PEPTIDE,84681,CPT,301,RC,,,,outpatient,,,18,1.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,18.51,18.51,18.51,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,283.54,283.54,283.54,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,54.1,54.1,54.58,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,20.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,43.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,18.51,18.51,18.51,11,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,20.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,44.98,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,21.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,20.81,448,,facility
AUTOMATED LEUKOCYTE COUNT,85048,CPT,305,RC,,,,outpatient,,,8,0.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,5.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.48,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,2.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,2.54,448,,facility
DETECT AGENT NOS DNA AMP,87798,CPT,306,RC,,,,outpatient,,,252.75,25.28,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,110.88,110.88,174.24,1 through 10,percent of total billed charges,,,33.6,,244.27,244.27,244.27,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,96.77,32.38,119.79,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,38.9,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
DRUG ASSAY VORICONAZOLE,80285,CPT,301,RC,,,,outpatient,,,150,15,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,24.11,24.11,24.11,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,27.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,56.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,28.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,24.11,24.11,24.11,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,27.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,28.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,47.44,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,27.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,27.11,448,,facility
VOLTAGE-GTD CA CHNL ANTB EA,86596,CPT,302,RC,,,,outpatient,,,225,22.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,36.48,36.48,36.48,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.72,10.72,10.72,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.2,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.05,448,,facility
GIARDIA AG IA,87329,CPT,306,RC,,,,outpatient,,,69,6.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.9,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.98,448,,facility
CLOT FACTOR FLETCHER FACT,85292,CPT,305,RC,,,,outpatient,,,150,15,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,39.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,20.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,20.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,40.9,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.93,448,,facility
VIRUS ANTIBODY NOS,86790,CPT,302,RC,,,,outpatient,,,41.5,4.15,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.46,11.46,11.46,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,107.86,20.06,169.49,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,116.52,40.29,122.3,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,26.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.46,11.46,11.46,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.88,448,,facility
DETECT AGENT NOS DNA QUANT,87799,CPT,306,RC,,,,outpatient,,,350,35,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,38.11,38.11,38.11,39,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,44.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,200.64,91.44,597.79,1 through 10,percent of total billed charges,,,33.6,,203.95,203.95,203.95,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,231.27,203.95,231.27,11,percent of total billed charges,,,34.6,,220.34,220.34,231.27,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,89.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,45.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,38.11,38.11,38.11,221,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,45.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,92.54,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,43.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,42.84,448,,facility
HEPATITIS B DNA QUANT,87517,CPT,306,RC,,,,outpatient,,,806,80.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,38.11,38.11,38.11,15,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,44.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,95.04,95.04,355.34,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,60.48,60.48,95.09,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,89.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,45.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,90,90,90,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,38.11,38.11,38.11,25,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,45.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,92.54,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,43.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,42.84,448,,facility
MOPATH PROCEDURE LEVEL 2,81401,CPT,310,RC,,,,outpatient,,,813,81.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,121.86,121.86,121.86,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,137,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,137,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,141.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,137,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,286.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,145.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,137,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,145.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,239.75,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,139.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,137,448,,facility
HEP B SURFACE AG NEUTRLZJ IA,87341,CPT,306,RC,,,,outpatient,,,45,4.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,21.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.31,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,10.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,10.33,448,,facility
ASSAY OF AMMONIA,82140,CPT,301,RC,,,,outpatient,,,59,5.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.96,12.96,12.96,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,65.18,29.57,110.77,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,29.92,29.92,29.92,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,30.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.96,12.96,12.96,51,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,31.48,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.57,448,,facility
ASSAY GROWTH HORMONE (HGH),83003,CPT,301,RC,,,,outpatient,,,14,1.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,14.83,14.83,14.83,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,202.13,202.13,202.13,1 through 10,percent of total billed charges,,,33.6,,29.9,29.9,29.9,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,34.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,14.83,14.83,14.83,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.02,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,16.67,448,,facility
ASSAY OF VIP,84586,CPT,301,RC,,,,outpatient,,,78.35,7.84,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,191.66,191.66,191.66,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,76.34,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,36.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.33,448,,facility
HPV HI-RISK TYP POOLED RSLT,87624,CPT,306,RC,,,,outpatient,,,72,7.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,51,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,57.23,57.23,57.23,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,85.34,51.22,134.11,1 through 10,percent of total billed charges,,,33.6,,32.59,32.59,85.34,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,85.34,75.94,85.34,14,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,112,48.5,112,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,20.37,20.37,53.34,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,80,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
OPIOID &OPIATE ANALOG 5/MORE,80364,CPT,301,RC,,,,outpatient,,,35,3.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
NPM1 GENE,81310,CPT,310,RC,,,,outpatient,,,305,30.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,219.28,219.28,219.28,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,246.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,246.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,253.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,246.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,515.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,261.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,246.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,261.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,431.41,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,251.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,246.52,515.23,,facility
ASSAY GALACTOSE TRANSFERASE,82775,CPT,301,RC,,,,outpatient,,,205.35,20.54,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,21.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,44.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,21.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,45.52,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,21.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,21.07,448,,facility
MLH1 GENE,81288,CPT,310,RC,,,,outpatient,,,480,48,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,192.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,192.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,198.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,192.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,401.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,203.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,192.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,203.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,336.56,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,196.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,192.32,448,,facility
ASSAY OF THIOCYANATE,84430,CPT,301,RC,,,,outpatient,,,87,8.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,24.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.13,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,11.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.63,448,,facility
MEASUREMENT OF ANTIBODY (IGG) TO ALLERGIC SUBSTANCE; EACH ALLERGEN,86001,CPT,0302,RC,,,,outpatient,,,29,2.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,7.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,16.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,7.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.69,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,7.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,7.82,448,,facility
CYTOGENETICS 100-300,88275,CPT,311,RC,,,,outpatient,,,219,21.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,45.53,45.53,45.53,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,51.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,51.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,52.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,1828.51,1828.51,1828.51,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,401.18,401.18,401.18,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,51.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,106.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,54.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,45.53,45.53,45.53,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,51.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,54.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,89.58,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,52.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,51.19,448,,facility
ASSAY OF ARSENIC,82175,CPT,301,RC,,,,outpatient,,,24.1,2.41,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.87,16.87,16.87,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,39.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,20.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.87,16.87,16.87,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,20.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,40.99,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.97,448,,facility
EPSTEIN-BARR CAPSID VCA,86665,CPT,302,RC,,,,outpatient,,,17.1,1.71,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.14,16.14,16.14,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,106.24,61.44,106.24,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,87.65,87.65,759.96,1 through 10,percent of total billed charges,,,33.6,,345.41,345.41,345.41,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,65.86,65.86,345.41,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,37.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.14,16.14,16.14,21,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,39.2,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.14,448,,facility
MOPATH PROCEDURE LEVEL 5,81404,CPT,310,RC,,,,outpatient,,,169,16.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,274.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,274.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,283.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,274.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,574.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,291.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,274.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,291.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,480.95,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,280.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,274.83,574.39,,facility
ASSAY OF ANGIOTENSIN II,82163,CPT,301,RC,,,,outpatient,,,158.6,15.86,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,20.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,42.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,21.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,20.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,21.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,44.35,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,20.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,20.52,448,,facility
T CELL ABSOLUTE COUNT,86361,CPT,302,RC,,,,outpatient,,,76.76,7.68,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,23.82,23.82,23.82,46,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,160.48,160.19,463.15,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,143.62,91.39,143.62,24,percent of total billed charges,,,33.6,,143.62,91.39,414.48,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,91.39,91.39,92.04,15,percent of total billed charges,,,34.6,,284.95,284.95,284.95,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,26.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,55.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,28.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,136,135.75,136,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,23.82,23.82,23.82,197,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,26.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,28.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,57.86,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,27.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,26.78,448,,facility
IMMUNOASSAY QUANT NOS NONAB,83520,CPT,301,RC,,,,outpatient,,,75,7.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,36,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,66.08,66.08,66.08,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,41.18,24.82,318.38,1 through 10,percent of total billed charges,,,33.6,,37.63,37.63,96.43,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,33.6,23.18,176.4,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,36.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,87,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.22,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.27,448,,facility
RIA NONANTIBODY,83519,CPT,301,RC,,,,outpatient,,,415,41.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,55.44,55.44,55.44,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.37,16.37,16.37,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.2,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.4,448,,facility
KETONE BODYS QUAN,82010,CPT,301,RC,,,,outpatient,,,36.15,3.62,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,7.27,7.27,7.27,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,59.66,59.14,100.5,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,17.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,7.27,7.27,7.27,32,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.66,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,8.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,8.17,448,,facility
AMINO ACIDS SINGLE QUANT,82131,CPT,301,RC,,,,outpatient,,,165,16.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,23.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,48.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,24.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,24.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,40.22,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,23.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,22.98,448,,facility
LACTOFERRIN FECAL (QUANT),83631,CPT,301,RC,,,,outpatient,,,224,22.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,41.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,20.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,20.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.42,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,20.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,19.63,448,,facility
QUANTITATIVE ASSAY DRUG,80299,CPT,301,RC,,,,outpatient,,,192,19.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,13,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,174.64,174.64,174.64,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,171.6,171.6,171.6,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,374.52,374.52,374.52,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.62,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.64,448,,facility
DRUG SCREENING BUPRENORPHINE,80348,CPT,301,RC,,,,outpatient,,,63,6.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
HEAVY METAL QUAN EACH NES,83018,CPT,301,RC,,,,outpatient,,,227.9,22.79,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,21.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,45.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,23.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,21.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,23.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,47.46,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,22.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,21.96,448,,facility
ANTIDEPRESSANT NOT SPECIFIED,80338,CPT,301,RC,,,,outpatient,,,268,26.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
ASSAY OF COPPER,82525,CPT,301,RC,,,,outpatient,,,47.7,4.77,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.04,11.04,11.04,18,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,35.64,22.85,35.9,1 through 10,percent of total billed charges,,,33.6,,80.64,80.64,80.64,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,22.85,19.49,22.85,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,50.4,50.4,50.4,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.04,11.04,11.04,37,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.81,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.41,448,,facility
DETECT AGENT NOS DNA AMP,87798,CPT,306,RC,,,,outpatient,,,184,18.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,110.88,110.88,174.24,1 through 10,percent of total billed charges,,,33.6,,244.27,244.27,244.27,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,96.77,32.38,119.79,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,38.9,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
EUGLOBULIN LYSIS,85360,CPT,305,RC,,,,outpatient,,,135,13.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,17.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.17,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,8.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,8.41,448,,facility
THROMBOPLASTIN TIME PARTIAL,85730,CPT,305,RC,,,,outpatient,,,25,2.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.35,5.35,5.35,44,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,17.28,17.28,226.56,25,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,208.86,15.93,208.86,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,186.91,11.69,202.13,44,percent of total billed charges,,,33.6,,118.94,9.07,237.89,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,118.94,9.07,120.01,25,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,12.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,177,13.5,177,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.35,5.35,5.35,310,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.99,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,6.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,6.01,448,,facility
DRUG SCREENING COCAINE,80353,CPT,301,RC,,,,outpatient,,,40,4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
THROMBIN TIME PLASMA,85670,CPT,305,RC,,,,outpatient,,,48,4.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,12.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.46,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.77,448,,facility
ASSAY OF URINE SODIUM,84300,CPT,301,RC,,,,outpatient,,,6.33,0.63,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.5,4.5,4.5,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,62.16,62.16,62.72,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,10.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,21.5,21.5,92.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.5,4.5,4.5,20,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.5,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.06,448,,facility
RBC SERUM PRETX INCUBJ/INHIB,86977,CPT,302,RC,,,,outpatient,,,258,25.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,167.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,340.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,172.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,172.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,226.07,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,166.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,163.06,448,,facility
ASSAY OF URINE SODIUM,84300,CPT,301,RC,,,,outpatient,,,43,4.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.5,4.5,4.5,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,62.16,62.16,62.72,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,10.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,21.5,21.5,92.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.5,4.5,4.5,20,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.5,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.06,448,,facility
BARTONELLA ANTIBODY,86611,CPT,302,RC,,,,outpatient,,,15.05,1.51,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,21.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9.05,9.05,9.05,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.98,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,10.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,10.18,448,,facility
MSH6 GENE DUP/DELETE VARIANT,81300,CPT,310,RC,,,,outpatient,,,108,10.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,238,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,238,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,245.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,238,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,497.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,252.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,238,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,252.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,416.5,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,242.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,238,497.42,,facility
ASSAY OF THEOPHYLLINE,80198,CPT,301,RC,,,,outpatient,,,15,1.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,29.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.56,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.14,448,,facility
DRUG ASSAY METHOTREXATE,80204,CPT,301,RC,,,,outpatient,,,27,2.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,39.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,38.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,80.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,40.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,34.31,34.31,34.31,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,38.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,40.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,67.5,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,39.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,38.57,448,,facility
FUNGUS NES ANTIBODY,86671,CPT,302,RC,,,,outpatient,,,240.15,24.02,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.48,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.25,448,,facility
COMPLETE CBC W/AUTO DIFF WBC,85025,CPT,305,RC,,,,outpatient,,,4.5,0.45,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,6.91,6.91,6.91,1297,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,36.48,36.16,237.44,624,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,33.63,33.34,218.89,55,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,36.16,36.16,36.16,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,124.66,19.15,211.84,728,percent of total billed charges,,,33.6,,124.66,19.15,195.89,174,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,19.15,19.15,125.77,706,percent of total billed charges,,,34.6,,134.67,21.53,141.35,26,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,7.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,16.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,28.5,28.25,185.5,63,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,77.91,11.97,77.91,28,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,0.22,0.22,0.22,1 through 10,percent of total billed charges,,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,6.91,6.91,6.91,5659,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,7.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.78,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,7.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,7.77,448,,facility
FACTOR INHIBITOR TEST,85335,CPT,305,RC,,,,outpatient,,,127.5,12.75,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.45,11.45,11.45,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,598.85,598.85,598.85,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,26.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.45,11.45,11.45,14,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.81,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.87,448,,facility
DRUG SCREENING PREGABALIN,80366,CPT,301,RC,,,,outpatient,,,35,3.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
MASS SPECTROMETRY QUAL/QUAN,83789,CPT,301,RC,,,,outpatient,,,92.25,9.23,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,24.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,50.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,25.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,24.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,25.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.19,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,24.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,24.11,448,,facility
DRUG SCREENING METHADONE,80358,CPT,301,RC,,,,outpatient,,,213,21.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
TB AG RESPONSE T-CELL SUSP,86481,CPT,302,RC,,,,outpatient,,,81.75,8.18,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,175,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100,448,,facility
HEMOGLOBIN PLASMA,83051,CPT,301,RC,,,,outpatient,,,36.05,3.61,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,7.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,15.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,7.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,7.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,7.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.8,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,7.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,7.31,448,,facility
IGK REARRANGEABN CLONAL POP,81264,CPT,310,RC,,,,outpatient,,,215,21.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,172.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,172.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,177.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,365.57,365.57,365.57,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,172.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,361.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,183.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,172.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,183.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,322.61,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,176.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,172.73,448,,facility
PTEN GENE FULL SEQUENCE,81321,CPT,310,RC,,,,outpatient,,,376,37.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,600,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,600,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,618,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,600,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1254,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,636,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,600,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,636,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1050,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,612,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1254,,facility
AMINO ACIDS SINGLE QUANT,82131,CPT,301,RC,,,,outpatient,,,31,3.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,23.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,48.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,24.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,24.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,40.22,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,23.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,22.98,448,,facility
ASSAY OF OXALATE,83945,CPT,301,RC,,,,outpatient,,,36.65,3.67,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,30.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.85,12.85,12.85,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.81,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.45,448,,facility
WBC ANTIBODY IDENTIFICATION,86021,CPT,302,RC,,,,outpatient,,,51,5.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.39,13.39,13.39,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,20.59,13.1,38.54,1 through 10,percent of total billed charges,,,33.6,,134.11,134.11,134.11,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,13.1,13.1,13.1,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,31.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.39,13.39,13.39,23,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.53,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,15.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,15.05,448,,facility
NUCLEAR ANTIGEN ANTIBODY,86235,CPT,302,RC,,,,outpatient,,,18,1.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13,12.5,15.95,11,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,54.91,4.37,90.29,43,percent of total billed charges,,,33.6,,4.37,4.37,53.09,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,22.18,4.24,83.33,13,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,37.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.95,13,15.95,54,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.75,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.93,448,,facility
DNA ANTIBODY NATIVE,86225,CPT,302,RC,,,,outpatient,,,34,3.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.22,12.22,12.22,16,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,32.21,29.57,46.46,11,percent of total billed charges,,,33.6,,29.57,29.57,29.57,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,29.66,29.57,98.11,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,28.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.22,12.22,12.22,49,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.7,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.74,448,,facility
ENCEPHALITIS CALIFORN ANTBDY,86651,CPT,302,RC,,,,outpatient,,,41.6,4.16,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.49,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.19,448,,facility
HISTOPLASMA ANTIBODY,86698,CPT,302,RC,,,,outpatient,,,38.7,3.87,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.27,12.27,12.27,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,28.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.27,12.27,12.27,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.79,448,,facility
IMMUNOASSAY QUANT NOS NONAB,83520,CPT,301,RC,,,,outpatient,,,58.1,5.81,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,36,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,66.08,66.08,66.08,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,41.18,24.82,318.38,1 through 10,percent of total billed charges,,,33.6,,37.63,37.63,96.43,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,33.6,23.18,176.4,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,36.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,87,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.22,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.27,448,,facility
ASSAY OF TOTAL TESTOSTERONE,84403,CPT,301,RC,,,,outpatient,,,30,3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,22.96,20,22.96,75,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,44.84,11.8,294.41,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,35.9,10.56,263.47,33,percent of total billed charges,,,33.6,,40.13,25.54,169.16,16,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,25.54,6.72,167.66,56,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,25.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,53.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,27.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,38,38,38,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,4.2,4.2,4.2,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,22.96,20,22.96,116,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,25.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,27.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,55.77,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,26.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,25.81,448,,facility
QUANTITATIVE ASSAY DRUG,80299,CPT,301,RC,,,,outpatient,,,126.75,12.68,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,13,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,174.64,174.64,174.64,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,171.6,171.6,171.6,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,374.52,374.52,374.52,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.62,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.64,448,,facility
DEOXYCORTISOL,82634,CPT,301,RC,,,,outpatient,,,68,6.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,29.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,61.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,31.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,29.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,31.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,63.25,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,29.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,29.28,448,,facility
DRUG/SUBSTANCE NOS 1-3,80375,CPT,301,RC,,,,outpatient,,,135,13.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
ASSAY OF URINE SODIUM,84300,CPT,301,RC,,,,outpatient,,,7,0.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.5,4.5,4.5,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,62.16,62.16,62.72,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,10.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,21.5,21.5,92.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.5,4.5,4.5,20,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.5,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.06,448,,facility
VITAMIN B-12,82607,CPT,301,RC,,,,outpatient,,,15,1.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.41,13.41,13.41,130,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,57.82,57.82,193.52,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,51.74,32.93,173.18,47,percent of total billed charges,,,33.6,,32.93,32.93,110.21,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,32.93,32.93,33.22,71,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,31.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,49,49,49,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,68.88,68.88,68.88,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.41,13.41,13.41,332,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.57,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,15.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,15.08,448,,facility
HEMOGLOBIN ELECTROPHORESIS,83020,CPT,301,RC,,,,outpatient,,,47,4.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.45,11.45,11.45,22,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,12.1,12.1,12.29,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,26.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,18,18,18,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,29.19,29.19,29.19,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.45,11.45,11.45,47,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.81,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.87,448,,facility
DRUG SCREENING OXYCODONE,80365,CPT,301,RC,,,,outpatient,,,101,10.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
DRUG TEST PRSMV CHEM ANLYZR,80307,CPT,301,RC,,,,outpatient,,,49,4.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,55.27,55.27,55.27,34,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,62.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,62.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,171.87,131.38,223.26,14,percent of total billed charges,,,33.6,,206.45,131.38,223.26,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,131.38,102.04,131.38,13,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,62.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,129.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,65.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,55.27,55.27,55.27,332,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,62.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,65.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,125.7,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,63.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,62.14,448,,facility
JAK2 GENE,81270,CPT,310,RC,,,,outpatient,,,250,25,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,91.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,91.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,94.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,297.36,297.36,297.36,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,91.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,191.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,97.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,175,175,175,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,81.53,81.53,81.53,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,91.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,97.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,198.05,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,93.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,91.66,448,,facility
ASSAY OF TOTAL THYROXINE,84436,CPT,301,RC,,,,outpatient,,,8,0.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,6.11,6.11,6.11,16,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,29.04,18.48,252.95,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,18.56,18.48,150.18,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,14.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,7.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,6.11,6.11,6.11,40,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,7.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.84,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,7.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,6.87,448,,facility
URINALYSIS VOLUME MEASURE,81050,CPT,307,RC,,,,outpatient,,,38,3.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.24,3.24,3.24,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,3.7,3.36,3.7,1 through 10,percent of total billed charges,,,33.6,,3.36,3.36,3.36,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,3.36,3.36,3.36,1 through 10,percent of total billed charges,,,34.6,,3.99,3.99,3.99,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,7.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.24,3.24,98.45,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.49,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,3.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,3.64,448,,facility
HIV-2 PROBE&REVRSE TRNSCRIPJ,87538,CPT,306,RC,,,,outpatient,,,106.5,10.65,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,122.13,122.13,122.13,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
IMMUNOASSAY QUANT NOS NONAB,83520,CPT,301,RC,,,,outpatient,,,56,5.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,36,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,66.08,66.08,66.08,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,41.18,24.82,318.38,1 through 10,percent of total billed charges,,,33.6,,37.63,37.63,96.43,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,33.6,23.18,176.4,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,36.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,87,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.22,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.27,448,,facility
DETECT AGENT NOS DNA AMP,87798,CPT,306,RC,,,,outpatient,,,142.5,14.25,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,110.88,110.88,174.24,1 through 10,percent of total billed charges,,,33.6,,244.27,244.27,244.27,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,96.77,32.38,119.79,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,38.9,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
ASSAY OF PSA FREE,84154,CPT,301,RC,,,,outpatient,,,10.5,1.05,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.36,16.36,16.36,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,32.74,32.74,42.77,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,5.71,5.71,5.71,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.36,16.36,16.36,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,39.74,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.39,448,,facility
PROTHROMBIN TIME,85610,CPT,305,RC,,,,outpatient,,,48,4.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.82,3.82,3.82,148,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,25.6,25.6,68.48,85,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,63.13,63.13,63.13,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,35.95,16.37,61.1,101,percent of total billed charges,,,33.6,,21.12,13.44,56.5,20,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,13.56,13.44,36.27,76,percent of total billed charges,,,34.6,,38.84,38.84,40.77,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,8.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,53.5,20,141,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,22.47,8.4,22.47,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.82,3.82,3.82,801,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.49,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,4.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,4.29,448,,facility
IMMUNOASSAY QUANT NOS NONAB,83520,CPT,301,RC,,,,outpatient,,,287,28.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,36,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,66.08,66.08,66.08,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,41.18,24.82,318.38,1 through 10,percent of total billed charges,,,33.6,,37.63,37.63,96.43,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,33.6,23.18,176.4,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,36.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,87,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.22,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.27,448,,facility
ASSAY IGA/IGD/IGG/IGM EACH,82784,CPT,301,RC,,,,outpatient,,,25.2,2.52,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,8.27,8.27,8.27,98,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,114.46,59,343.38,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,52.8,30.49,158.4,64,percent of total billed charges,,,33.6,,19.58,19.49,33.6,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,53.09,19.49,195.55,67,percent of total billed charges,,,34.6,,190.57,73.91,336.04,67,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,9.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,19.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,9.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,29,29,50,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,8.27,8.27,8.27,371,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,9.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,9.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.09,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,9.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,9.3,448,,facility
HEMOGLOBIN ELECTROPHORESIS,83020,CPT,301,RC,,,,outpatient,,,286,28.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.45,11.45,11.45,22,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,12.1,12.1,12.29,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,26.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,18,18,18,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,29.19,29.19,29.19,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.45,11.45,11.45,47,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.81,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.87,448,,facility
FATS/LIPIDS FECES QUAL,82705,CPT,301,RC,,,,outpatient,,,25,2.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,10.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.54,4.54,4.54,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.01,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.1,448,,facility
HEMOGLOBIN ELECTROPHORESIS,83020,CPT,301,RC,,,,outpatient,,,23.6,2.36,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.45,11.45,11.45,22,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,12.1,12.1,12.29,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,26.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,18,18,18,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,29.19,29.19,29.19,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.45,11.45,11.45,47,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.81,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.87,448,,facility
INTRINSIC FACTOR ANTIBODY,86340,CPT,302,RC,,,,outpatient,,,106.5,10.65,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,59.14,59.14,74.98,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,31.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.41,13.41,13.41,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.57,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,15.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,15.08,448,,facility
CLOTTING FUNCT ACTIVITY,85397,CPT,305,RC,,,,outpatient,,,214,21.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,27.45,27.45,27.45,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,31.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,30.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,64.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,32.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,27.45,27.45,27.45,13,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,30.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,32.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,54.01,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,31.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,30.86,448,,facility
ASSAY OF BLOOD/URIC ACID,84550,CPT,301,RC,,,,outpatient,,,4,0.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.02,4.02,4.02,51,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,23.6,23.6,23.6,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,75.26,21.12,118.27,23,percent of total billed charges,,,33.6,,75.26,75.26,75.26,42,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,75.26,13.44,85.34,40,percent of total billed charges,,,34.6,,81.31,81.31,85.34,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,9.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,47.04,47.04,47.04,18,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.02,4.02,4.02,166,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.77,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,4.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,4.52,448,,facility
PML/RARALPHA COM BREAKPOINTS,81315,CPT,310,RC,,,,outpatient,,,835,83.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,184.4,184.4,184.4,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,207.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,207.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,213.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,207.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,433.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,219.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,184.4,184.4,184.4,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,207.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,219.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,447.9,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,211.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,207.31,448,,facility
DRUG SCREENING BUPRENORPHINE,80348,CPT,301,RC,,,,outpatient,,,40,4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
IMMUNE COMPLEX ASSAY,86332,CPT,302,RC,,,,outpatient,,,46.9,4.69,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,24.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,50.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,25.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,24.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,25.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,52.66,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,24.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,24.37,448,,facility
DRUG ASY HYDROXYCHLOROQUINE,80220,CPT,301,RC,,,,outpatient,,,400,40,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.62,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.64,448,,facility
N.GONORRHOEAE DNA AMP PROB,87591,CPT,306,RC,,,,outpatient,,,197,19.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,442,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,50.15,20.65,65.49,11,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,228.48,228.48,228.48,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,37.3,18.48,58.61,60,percent of total billed charges,,,33.6,,37.3,11.76,63.38,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,28.82,11.76,37.3,69,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,42.5,17.5,55.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,23.31,23.31,23.31,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,31.21,31.21,31.21,1 through 10,percent of total billed charges,,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,796,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
ASSAY OF LDH ENZYMES,83625,CPT,301,RC,,,,outpatient,,,24.5,2.45,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,26.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.65,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.79,448,,facility
SMEAR FLUORESCENT/ACID STAI,87206,CPT,306,RC,,,,outpatient,,,10.5,1.05,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.79,4.79,4.79,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,11.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.79,4.79,4.79,21,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.64,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.39,448,,facility
HEROIN METABOLITE,80356,CPT,301,RC,,,,outpatient,,,246,24.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
IMMUNOASSAY NONANTIBODY,83516,CPT,301,RC,,,,outpatient,,,21.85,2.19,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9,9,10.26,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,4.75,4.75,218.59,30,percent of total billed charges,,,33.6,,3.02,3.02,175.39,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,3.02,3.02,211.68,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,24.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,23.5,23.5,23.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9,9,10.26,51,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.92,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,11.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.53,448,,facility
ASSAY OF VITAMIN B-2,84252,CPT,301,RC,,,,outpatient,,,37.2,3.72,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,18,18,18,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,20.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,42.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,21.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,20.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,21.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,43.72,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,20.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,20.24,448,,facility
IMMUNOGLOBULIN ASSAY,86023,CPT,302,RC,,,,outpatient,,,112,11.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,26.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.92,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.46,448,,facility
AMINO ACIDS QUAN 6 OR MORE,82139,CPT,301,RC,,,,outpatient,,,6.1,0.61,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.01,12,15.01,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,230.18,110.21,262.42,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,35.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,164.01,164.01,164.01,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.01,12,15.01,16,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.45,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,16.87,448,,facility
DRUG ASSAY INFLIXIMAB,80230,CPT,301,RC,,,,outpatient,,,300,30,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,39.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,38.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,80.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,40.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,38.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,40.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,67.5,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,39.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,38.57,448,,facility
CHEMILUMINESCENT ASSAY,82397,CPT,301,RC,,,,outpatient,,,120.9,12.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.56,12.56,12.56,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,22.85,22.85,22.85,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,29.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.56,12.56,12.56,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.5,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.12,448,,facility
IMMUNOASSAY QUANT NOS NONAB,83520,CPT,301,RC,,,,outpatient,,,59.65,5.97,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,36,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,66.08,66.08,66.08,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,41.18,24.82,318.38,1 through 10,percent of total billed charges,,,33.6,,37.63,37.63,96.43,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,33.6,23.18,176.4,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,36.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,87,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.22,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.27,448,,facility
COMPLEMENT ANTIGEN,86160,CPT,302,RC,,,,outpatient,,,40.8,4.08,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.67,10.67,10.67,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,87.32,87.32,87.32,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,78.14,49.73,270.86,17,percent of total billed charges,,,33.6,,49.73,49.73,172.37,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,49.73,29.23,50.32,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,256.5,256.5,256.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.67,10.67,10.67,61,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.92,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12,448,,facility
DRUG SCREENING TRAMADOL,80373,CPT,301,RC,,,,outpatient,,,213,21.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
Q FEVER ANTIBODY,86638,CPT,302,RC,,,,outpatient,,,43.2,4.32,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.2,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.12,448,,facility
COOMBS TEST DIRECT,86880,CPT,302,RC,,,,outpatient,,,12,1.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,52.12,52.12,52.12,13,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,56.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,56.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,58.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,272.45,57.02,294.64,27,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,57.79,57.79,57.79,1 through 10,percent of total billed charges,,,34.6,,187.31,187.31,187.31,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,56.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,118,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,59.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.79,4.79,4.79,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,56.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,59.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.64,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,57.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.64,448,,facility
FUNGUS NES ANTIBODY,86671,CPT,302,RC,,,,outpatient,,,37.5,3.75,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.48,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.25,448,,facility
ENTEROVIRUS ANTIBODY,86658,CPT,302,RC,,,,outpatient,,,22.8,2.28,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.14,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.03,448,,facility
CLOT INHIBIT PROT S FREE,85306,CPT,305,RC,,,,outpatient,,,66,6.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.63,13.63,13.63,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,29.04,18.48,29.04,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,81.65,81.65,81.65,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,32.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.63,13.63,13.63,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,33.11,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,15.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,15.32,448,,facility
ANTIDEPRESSANTS CLASS 6/MORE,80334,CPT,301,RC,,,,outpatient,,,40,4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
CULTURE AEROBIC QUANT OTHER,87071,CPT,306,RC,,,,outpatient,,,28,2.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,9.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,20.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,9.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.41,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,10.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,9.89,448,,facility
CHLMYD TRACH DNA AMP PROBE,87491,CPT,306,RC,,,,outpatient,,,30.5,3.05,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,442,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,20.65,20.65,65.49,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,232.32,232.32,232.32,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,37.3,18.48,58.61,62,percent of total billed charges,,,33.6,,37.3,11.76,63.38,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,28.82,11.76,37.3,69,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,42.5,17.5,55.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,23.31,23.31,23.31,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,31.21,31.21,31.21,1 through 10,percent of total billed charges,,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,796,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
SMEAR FLUORESCENT/ACID STAI,87206,CPT,306,RC,,,,outpatient,,,15,1.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.79,4.79,4.79,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,11.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.79,4.79,4.79,21,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.64,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.39,448,,facility
VIRUS INOCULATE TISSUE ADDL,87253,CPT,306,RC,,,,outpatient,,,183,18.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,20.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,42.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,21.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,20.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,21.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,43.65,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,20.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,20.2,448,,facility
ASSAY THREE CATECHOLAMINES,82384,CPT,301,RC,,,,outpatient,,,47.5,4.75,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,22.46,22.46,22.46,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,25.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,52.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,26.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,22.46,22.46,22.46,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,25.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,26.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,54.57,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,25.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,25.25,448,,facility
PLACENTAL LACTOGEN,83632,CPT,301,RC,,,,outpatient,,,168.6,16.86,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,20.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,42.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,21.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,20.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,21.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,43.7,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,20.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,20.22,448,,facility
DRUG SCREEN QUANT TIAGABINE,80199,CPT,301,RC,,,,outpatient,,,60,6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,27.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,56.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,28.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,27.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,28.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,47.44,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,27.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,27.11,448,,facility
LYMPHOCYTE TRANSFORMATION,86353,CPT,302,RC,,,,outpatient,,,174,17.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,49.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,49.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,50.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,49.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,102.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,51.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,49.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,51.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,105.93,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,50.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,49.03,448,,facility
ANTIDEPRESSANTS CLASS 6/MORE,80334,CPT,301,RC,,,,outpatient,,,35,3.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
PARVOVIRUS ANTIBODY,86747,CPT,302,RC,,,,outpatient,,,21.5,2.15,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,31.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.48,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,15.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,15.03,448,,facility
HERPES SIMPLEX TYPE 2 TEST,86696,CPT,302,RC,,,,outpatient,,,38,3.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,17.21,17.21,17.21,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,20.59,20.59,42.71,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,13.1,13.1,13.1,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,40.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,20.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,17.21,17.21,17.21,12,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,20.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,41.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,19.35,448,,facility
BLOOD SPLIT UNIT,P9011,HCPCS,390,RC,,,,outpatient,,,513,51.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,141.8,130.8,155.08,21,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,558.72,558.72,558.72,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,155.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,155.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,159.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,155.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,324.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,164.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,155.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,164.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,107,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,158.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,107,448,,facility
RICKETTSIA ANTIBODY,86757,CPT,302,RC,,,,outpatient,,,21.6,2.16,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,17.21,17.21,17.21,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,40.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,20.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,17.21,17.21,17.21,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,20.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,41.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,19.35,448,,facility
ASY HYDROXYCORTICOSTEROIDS17,83491,CPT,301,RC,,,,outpatient,,,115.6,11.56,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,37.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,37.87,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.9,448,,facility
AMINO ACIDS QUAN 6 OR MORE,82139,CPT,301,RC,,,,outpatient,,,239,23.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.01,12,15.01,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,230.18,110.21,262.42,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,35.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,164.01,164.01,164.01,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.01,12,15.01,16,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.45,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,16.87,448,,facility
DETECT AGENT NOS DNA AMP,87798,CPT,306,RC,,,,outpatient,,,82,8.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,110.88,110.88,174.24,1 through 10,percent of total billed charges,,,33.6,,244.27,244.27,244.27,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,96.77,32.38,119.79,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,38.9,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
HEPARIN NEUTRALIZATION,85525,CPT,305,RC,,,,outpatient,,,128,12.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,24.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.59,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.84,448,,facility
CLTX CARPL SCPHD FX W/MNPJ,25624,CPT,450,RC,,,,outpatient,,,1914.16,191.42,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1585.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3216.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1631.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1631.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1569.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3216.38,,facility
DESOXYCORTICOSTERONE,82633,CPT,301,RC,,,,outpatient,,,89.95,9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,31.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,30.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,64.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,32.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,30.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,32.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,66.94,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,31.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,30.98,448,,facility
LONG CHAIN FATTY ACIDS,82726,CPT,301,RC,,,,outpatient,,,250,25,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,17.57,17.57,17.57,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,41.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,20.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,20.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,39.01,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,20.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,19.75,448,,facility
ASSAY PH BODY FLUID NOS,83986,CPT,301,RC,,,,outpatient,,,38,3.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.18,3.18,3.18,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,75.43,75.43,75.43,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,7.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.18,3.18,3.18,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.74,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,3.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,3.58,448,,facility
ASSAY OF URINE CHLORIDE,82436,CPT,301,RC,,,,outpatient,,,38,3.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.11,5.11,5.11,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,91.39,91.39,92.21,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,12.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,24.5,24.5,136,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.11,5.11,5.11,20,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.87,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.75,448,,facility
DETECT AGENT NOS DNA AMP,87798,CPT,306,RC,,,,outpatient,,,288,28.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,110.88,110.88,174.24,1 through 10,percent of total billed charges,,,33.6,,244.27,244.27,244.27,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,96.77,32.38,119.79,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,38.9,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
FLT3 GENE,81245,CPT,310,RC,,,,outpatient,,,450,45,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,165.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,165.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,170.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,165.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,345.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,175.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,165.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,175.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,289.64,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,168.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,165.51,448,,facility
STR MARKERS SPECIMEN ANAL,81265,CPT,310,RC,,,,outpatient,,,660,66,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,207.31,207.31,207.31,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,233.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,233.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,240.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,233.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,487.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,247.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,233.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,247.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,464.61,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,237.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,233.07,487.12,,facility
HELMINTH ANTIBODY,86682,CPT,302,RC,,,,outpatient,,,69.75,6.98,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.57,11.57,11.57,36,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,56.78,56.78,66.44,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.57,11.57,11.57,12,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.11,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.01,448,,facility
ASSAY OF NATRIURETIC PEPTIDE,83880,CPT,301,RC,,,,outpatient,,,172.5,17.25,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,34.92,34.92,34.92,37,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,39.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,39.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,40.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,261.74,127.51,444.81,39,percent of total billed charges,,,33.6,,261.74,261.74,444.81,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,81.87,81.31,261.74,29,percent of total billed charges,,,34.6,,89.35,89.35,89.35,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,39.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,82.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,41.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,389.5,389.5,389.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,34.92,34.92,34.92,366,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,39.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,41.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,73.33,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,40.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,39.26,448,,facility
DRUG SCREENING OXYCODONE,80365,CPT,301,RC,,,,outpatient,,,246,24.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
INFLUENZA VIRUS ANTIBODY,86710,CPT,302,RC,,,,outpatient,,,37.8,3.78,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,28.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.28,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.55,448,,facility
IMMUNOASSAY TUMOR CA 15-3,86300,CPT,302,RC,,,,outpatient,,,32,3.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,204.29,204.29,204.29,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,20.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,43.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,18.51,18.51,18.51,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,20.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,44.98,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,21.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,20.81,448,,facility
DNA ANTIBODY NATIVE,86225,CPT,302,RC,,,,outpatient,,,136,13.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.22,12.22,12.22,16,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,32.21,29.57,46.46,11,percent of total billed charges,,,33.6,,29.57,29.57,29.57,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,29.66,29.57,98.11,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,28.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.22,12.22,12.22,49,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.7,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.74,448,,facility
DGP ANTIBODY EACH IG CLASS,86258,CPT,302,RC,,,,outpatient,,,25.75,2.58,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.72,10.72,10.72,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,10.62,10.62,10.62,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,31.58,6.1,49.63,18,percent of total billed charges,,,33.6,,6.05,6.05,6.05,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,6.05,6.05,6.1,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,9,9,9,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.72,10.72,10.72,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.18,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.05,448,,facility
ANTINUCLEAR ANTIBODIES (ANA),86039,CPT,302,RC,,,,outpatient,,,15,1.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5,5,5,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,11.76,11.76,11.76,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,1.68,1.68,1.68,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,23.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9.93,5,9.93,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.12,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,11.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.16,448,,facility
DRUG/SUBSTANCE NOS 1-3,80375,CPT,301,RC,,,,outpatient,,,196.5,19.65,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
ANTINUCLEAR ANTIBODIES,86038,CPT,302,RC,,,,outpatient,,,70,7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.75,10.75,10.75,34,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,148.09,148.09,148.09,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,84.34,29.04,132.53,14,percent of total billed charges,,,33.6,,84.34,18.48,127.78,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,84.34,84.34,85.09,12,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,11.55,11.55,11.55,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.75,10.75,10.75,126,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.11,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.09,448,,facility
CLOT FACTOR VIII AHG 1 STAGE,85240,CPT,305,RC,,,,outpatient,,,181,18.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.92,15.92,15.92,48,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,98.21,62.5,349.44,1 through 10,percent of total billed charges,,,33.6,,62.5,62.5,62.5,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,62.88,62.5,62.88,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,37.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,93,92.75,93,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.92,15.92,15.92,80,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.68,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.9,448,,facility
DGP ANTIBODY EACH IG CLASS,86258,CPT,302,RC,,,,outpatient,,,9,0.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.72,10.72,10.72,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,10.62,10.62,10.62,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,31.58,6.1,49.63,18,percent of total billed charges,,,33.6,,6.05,6.05,6.05,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,6.05,6.05,6.1,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,9,9,9,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.72,10.72,10.72,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.18,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.05,448,,facility
BLASTOMYCES ANTIBODY,86612,CPT,302,RC,,,,outpatient,,,32.5,3.25,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,26.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.88,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.9,448,,facility
COCCIDIOIDES ANTIBODY,86635,CPT,302,RC,,,,outpatient,,,149,14.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,107.18,107.18,107.18,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,23.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.2,10.2,10.2,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.8,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,11.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.47,448,,facility
ASSAY OF ANDROSTENEDIONE,82157,CPT,301,RC,,,,outpatient,,,68,6.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,26.04,26.04,26.04,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,29.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,61.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,31.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,26.04,0.22,26.04,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,29.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,31.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,63.25,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,29.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,29.28,448,,facility
C-REACTIVE PROTEIN HS,86141,CPT,302,RC,,,,outpatient,,,12,1.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.52,11.52,11.52,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,35.38,35.38,35.38,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,22.51,22.51,22.54,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.52,11.52,11.52,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.97,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.95,448,,facility
DETECT AGENT NOS DNA AMP,87798,CPT,306,RC,,,,outpatient,,,132,13.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,110.88,110.88,174.24,1 through 10,percent of total billed charges,,,33.6,,244.27,244.27,244.27,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,96.77,32.38,119.79,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,38.9,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
ASSAY OF TACROLIMUS,80197,CPT,301,RC,,,,outpatient,,,276,27.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.21,12.21,12.21,100,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,71.44,70.9,318.86,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,361.57,70.9,361.57,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,28.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.21,12.21,12.21,313,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.68,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.73,448,,facility
RBC ANTIBODY ELUTION,86860,CPT,302,RC,,,,outpatient,,,90,9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,167.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,289.34,289.34,312.91,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,340.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,172.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,172.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,226.07,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,166.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,163.06,448,,facility
WESTERN BLOT TEST,84181,CPT,301,RC,,,,outpatient,,,296,29.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,35.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.79,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.03,448,,facility
ASSAY OF URINE POTASSIUM,84133,CPT,301,RC,,,,outpatient,,,7,0.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.21,4.21,4.21,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,22.51,22.51,22.71,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,9.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,9.5,9.5,33.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.21,4.21,4.21,20,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.31,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,4.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,4.73,448,,facility
BRUCELLA ANTIBODY,86622,CPT,302,RC,,,,outpatient,,,38.2,3.82,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,18.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,9.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,7.94,7.94,7.94,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,9.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.3,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,9.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,8.93,448,,facility
THROMBOPLASTIN INHIBITION,85705,CPT,305,RC,,,,outpatient,,,64,6.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,9.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,20.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,9.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.81,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,9.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,9.63,448,,facility
DETECT AGENT NOS DNA AMP,87798,CPT,306,RC,,,,outpatient,,,139.5,13.95,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,110.88,110.88,174.24,1 through 10,percent of total billed charges,,,33.6,,244.27,244.27,244.27,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,96.77,32.38,119.79,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,38.9,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
TREPONEMA PALLIDUM,86780,CPT,302,RC,,,,outpatient,,,32,3.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.78,11.78,11.78,612,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,10.62,10.62,50.15,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,9.5,6.05,48.53,46,percent of total billed charges,,,33.6,,6.05,6.05,44.88,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,6.05,6.05,28.56,66,percent of total billed charges,,,34.6,,73.69,20.19,77.34,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,9,9,42.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,17.85,17.85,17.85,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,11.78,11.78,11.78,1 through 10,percent of total billed charges,,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.78,11.78,11.78,550,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.6,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.24,448,,facility
IMMUNOASSAY TUMOR CA 19-9,86301,CPT,302,RC,,,,outpatient,,,30.4,3.04,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,18.51,18.51,18.51,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,128.41,40.13,163.31,1 through 10,percent of total billed charges,,,33.6,,96.1,96.1,96.1,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,96.1,25.54,96.95,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,20.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,43.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,60.06,60.06,60.06,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,18.51,18.51,18.51,16,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,20.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,44.98,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,21.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,20.81,448,,facility
QUANTITATIVE ASSAY DRUG,80299,CPT,301,RC,,,,outpatient,,,132,13.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,13,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,174.64,174.64,174.64,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,171.6,171.6,171.6,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,374.52,374.52,374.52,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.62,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.64,448,,facility
PROTEIN E-PHORESIS/URINE/CSF,84166,CPT,301,RC,,,,outpatient,,,36.75,3.68,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.86,15.86,15.86,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,21.5,21.5,21.5,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,21.58,21.58,21.58,1 through 10,percent of total billed charges,,,34.6,,87.63,87.63,89.3,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,37.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.86,15.86,15.86,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.52,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.83,448,,facility
MASS SPECTROMETRY QUAL/QUAN,83789,CPT,301,RC,,,,outpatient,,,345,34.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,24.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,50.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,25.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,24.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,25.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.19,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,24.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,24.11,448,,facility
HRDTRY PERPH NEURPHY PANEL,81448,CPT,310,RC,,,,outpatient,,,3775,377.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,584.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,584.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,602.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,584.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1222.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,619.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,584.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,619.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1263.68,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,596.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1263.68,,facility
EGFR GENE COM VARIANTS,81235,CPT,310,RC,,,,outpatient,,,1700,170,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,324.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,324.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,334.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,324.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,678.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,344.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,324.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,344.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,568.02,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,331.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,324.58,678.37,,facility
FIBRIN DEGRADATION QUANT,85379,CPT,305,RC,,,,outpatient,,,39,3.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9.05,9.05,9.05,15,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,20.36,20.36,20.36,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,243.82,143.47,243.82,35,percent of total billed charges,,,33.6,,172.63,67.58,243.82,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,143.47,43.01,144.75,15,percent of total billed charges,,,34.6,,157.99,157.99,157.99,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,21.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,213.5,213.5,213.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,89.67,89.67,89.67,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9.05,9.05,9.05,185,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.98,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,10.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,10.18,448,,facility
MYCOBACTERIA CULTURE,87116,CPT,306,RC,,,,outpatient,,,23,2.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9.61,9.61,9.61,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,22.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9.61,9.61,9.61,23,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,23.35,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,11.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,10.8,448,,facility
IMMUNOASSAY NONANTIBODY,83516,CPT,301,RC,,,,outpatient,,,465,46.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9,9,10.26,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,4.75,4.75,218.59,30,percent of total billed charges,,,33.6,,3.02,3.02,175.39,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,3.02,3.02,211.68,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,24.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,23.5,23.5,23.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9,9,10.26,51,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.92,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,11.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.53,448,,facility
DETECT AGENT NOS DNA AMP,87798,CPT,306,RC,,,,outpatient,,,378,37.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,110.88,110.88,174.24,1 through 10,percent of total billed charges,,,33.6,,244.27,244.27,244.27,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,96.77,32.38,119.79,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,38.9,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
FLUORESCENT ANTIBODY SCREEN,86255,CPT,302,RC,,,,outpatient,,,87,8.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.72,10.72,10.72,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,45.41,28.9,1068.67,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,28.9,28.9,28.9,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.72,10.72,10.72,19,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.04,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.05,448,,facility
ASSAY OF GLYCATED PROTEIN,82985,CPT,301,RC,,,,outpatient,,,30.4,3.04,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,14.91,14.91,14.91,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,29.57,29.57,29.57,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,35.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,14.91,14.91,14.91,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.57,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,16.76,448,,facility
ASSAY OF URINE SODIUM,84300,CPT,301,RC,,,,outpatient,,,37,3.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.5,4.5,4.5,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,62.16,62.16,62.72,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,10.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,21.5,21.5,92.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.5,4.5,4.5,20,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.5,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.06,448,,facility
ENCEPHALITIS CALIFORN ANTBDY,86651,CPT,302,RC,,,,outpatient,,,80,8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.49,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.19,448,,facility
QUANTITATIVE ASSAY DRUG,80299,CPT,301,RC,,,,outpatient,,,41.5,4.15,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,13,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,174.64,174.64,174.64,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,171.6,171.6,171.6,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,374.52,374.52,374.52,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.62,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.64,448,,facility
FIBRINOLYTIC PLASMINOGEN,85420,CPT,305,RC,,,,outpatient,,,56.25,5.63,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,13.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.11,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,6.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,6.53,448,,facility
ASSAY OF HOMOCYSTEINE,83090,CPT,301,RC,,,,outpatient,,,30,3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.94,15.94,15.94,15,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,34.32,21.84,34.32,1 through 10,percent of total billed charges,,,33.6,,34.45,34.45,73.25,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,37.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.94,15.94,15.94,13,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.45,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.92,448,,facility
DNA ANTIBODY NATIVE,86225,CPT,302,RC,,,,outpatient,,,47,4.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.22,12.22,12.22,16,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,32.21,29.57,46.46,11,percent of total billed charges,,,33.6,,29.57,29.57,29.57,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,29.66,29.57,98.11,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,28.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.22,12.22,12.22,49,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.7,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.74,448,,facility
DNA/RNA SEQUENCING,87153,CPT,306,RC,,,,outpatient,,,253.5,25.35,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,102.61,102.61,102.61,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,115.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,115.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,118.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,385.39,385.39,385.39,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,115.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,241.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,122.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,115.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,122.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,249.24,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,117.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,115.36,448,,facility
ASSAY OF ALDOSTERONE,82088,CPT,301,RC,,,,outpatient,,,35.8,3.58,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,36.25,36.25,36.25,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,32.45,32.45,63.72,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,40.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,40.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,41.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,29.04,18.48,29.04,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,18.48,17.81,46.37,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,40.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,85.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,43.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,36.25,36.25,36.25,24,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,40.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,43.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,88.04,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,41.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,40.75,448,,facility
ASSAY OF URINE/URIC ACID,84560,CPT,301,RC,,,,outpatient,,,7,0.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.52,4.52,4.52,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,10.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.26,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.08,448,,facility
ALPHA-1-ANTITRYPSIN PHENO,82104,CPT,301,RC,,,,outpatient,,,6.8,0.68,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10,10,12.86,11,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,16.46,16.46,25.87,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,3.36,3.36,3.36,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,30.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10,10,12.86,42,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,31.26,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.46,448,,facility
DETECT AGENT NOS DNA QUANT,87799,CPT,306,RC,,,,outpatient,,,400,40,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,38.11,38.11,38.11,39,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,44.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,200.64,91.44,597.79,1 through 10,percent of total billed charges,,,33.6,,203.95,203.95,203.95,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,231.27,203.95,231.27,11,percent of total billed charges,,,34.6,,220.34,220.34,231.27,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,89.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,45.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,38.11,38.11,38.11,221,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,45.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,92.54,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,43.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,42.84,448,,facility
ASSAY OF PREALBUMIN,84134,CPT,301,RC,,,,outpatient,,,12,1.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.98,12.98,12.98,37,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,47.52,47.52,166.73,1 through 10,percent of total billed charges,,,33.6,,98.11,98.11,98.11,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,30.24,30.24,98.99,16,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,30.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,18.9,18.9,18.9,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.98,12.98,12.98,128,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,31.52,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.59,448,,facility
DEOXYRIBONUCLEASE ANTIBODY,86215,CPT,302,RC,,,,outpatient,,,43,4.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.79,11.79,11.79,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.61,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.25,448,,facility
GTT-ADDED SAMPLES,82952,CPT,301,RC,,,,outpatient,,,6,0.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,20.59,20.33,43.82,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,13.1,13.05,13.1,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,8.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.47,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,3.92,448,,facility
ASSAY IGA/IGD/IGG/IGM EACH,82784,CPT,301,RC,,,,outpatient,,,29,2.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,8.27,8.27,8.27,98,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,114.46,59,343.38,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,52.8,30.49,158.4,64,percent of total billed charges,,,33.6,,19.58,19.49,33.6,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,53.09,19.49,195.55,67,percent of total billed charges,,,34.6,,190.57,73.91,336.04,67,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,9.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,19.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,9.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,29,29,50,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,8.27,8.27,8.27,371,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,9.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,9.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.09,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,9.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,9.3,448,,facility
ASSAY OF BLOOD CHLORIDE,82435,CPT,301,RC,,,,outpatient,,,15,1.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,9.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.09,4.09,4.09,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.94,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,4.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,4.6,448,,facility
ADENOVIRUS AG IF,87260,CPT,306,RC,,,,outpatient,,,61,6.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,30.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.9,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.43,448,,facility
ASSAY OF VITAMIN B-6,84207,CPT,301,RC,,,,outpatient,,,255,25.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,24.99,24.99,24.99,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,48.53,48.53,48.53,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,43.43,43.43,43.43,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,27.55,18.82,27.55,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,28.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,58.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,29.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,24.99,24.99,24.99,18,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,28.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,29.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,60.71,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,28.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,28.1,448,,facility
HRDTRY BRST CA-RLATD DO 5+,81432,CPT,310,RC,,,,outpatient,,,3182,318.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1303.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1303.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1343.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,2654.4,2654.4,2654.4,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1303.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,2725.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1382.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1303.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1382.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1467.08,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1330.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,2725.26,,facility
T CELL ABSOLUTE COUNT/RATIO,86360,CPT,302,RC,,,,outpatient,,,549,54.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,41.79,41.79,41.79,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,64.31,64.31,64.31,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,46.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,46.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,48.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,31.15,31.15,31.15,1 through 10,percent of total billed charges,,,33.6,,41.79,41.79,41.79,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,288.04,288.04,288.04,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,46.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,98.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,49.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,41.79,41.79,41.79,27,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,46.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,49.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,101.52,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,47.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,46.98,448,,facility
FLUORESCENT ANTIBODY SCREEN,86255,CPT,302,RC,,,,outpatient,,,55,5.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.72,10.72,10.72,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,45.41,28.9,1068.67,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,28.9,28.9,28.9,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.72,10.72,10.72,19,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.04,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.05,448,,facility
FIBRINOLYSINS SCREEN I&R,85390,CPT,305,RC,,,,outpatient,,,22,2.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.77,13.77,13.77,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,24.82,24.82,24.82,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,9.07,9.07,9.07,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,32.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.77,13.77,13.77,12,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.09,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,15.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,15.48,448,,facility
VIRUS ANTIBODY NOS,86790,CPT,302,RC,,,,outpatient,,,96,9.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.46,11.46,11.46,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,107.86,20.06,169.49,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,116.52,40.29,122.3,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,26.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.46,11.46,11.46,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.88,448,,facility
INHIBIN A,86336,CPT,302,RC,,,,outpatient,,,26,2.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.87,13.87,13.87,11,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,102.48,102.48,102.48,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,12.1,12.1,25.54,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,32.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.87,13.87,13.87,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,33.67,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,15.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,15.59,448,,facility
PHENOTYPE INFECT AGENT DRUG,87900,CPT,306,RC,,,,outpatient,,,362,36.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,130.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,130.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,134.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,130.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,272.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,138.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,130.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,138.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,281.61,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,132.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,130.35,448,,facility
RUSSELL VIPER VENOM DILUTED,85613,CPT,305,RC,,,,outpatient,,,54,5.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,8.52,8.52,8.52,20,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,82.37,20.06,82.37,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,52.42,52.42,52.42,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,9.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,20.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,8.52,8.52,8.52,34,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,9.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.7,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,9.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,9.58,448,,facility
FLUORESCENT ANTIBODY SCREEN,86255,CPT,302,RC,,,,outpatient,,,474,47.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.72,10.72,10.72,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,45.41,28.9,1068.67,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,28.9,28.9,28.9,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.72,10.72,10.72,19,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.04,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.05,448,,facility
AUTOMATED PLATELET COUNT,85049,CPT,305,RC,,,,outpatient,,,10,1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,9.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.98,3.98,3.98,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.68,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,4.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,4.48,448,,facility
DRUG SCREENING PROPOXYPHENE,80367,CPT,301,RC,,,,outpatient,,,40,4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
COL CHROMOTOGRAPHY QUAL/QUAN,82542,CPT,301,RC,,,,outpatient,,,265,26.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,21.43,21.43,21.43,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,435.07,435.07,435.07,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,24.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,50.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,25.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,21.43,21.43,21.43,15,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,24.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,25.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.16,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,24.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,24.09,448,,facility
AUTOMATED RBC COUNT,85041,CPT,305,RC,,,,outpatient,,,35,3.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,6.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.53,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,3.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,3.02,448,,facility
TISSUE HOMOGENIZATION CULTR,87176,CPT,306,RC,,,,outpatient,,,10,1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,12.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.71,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.88,448,,facility
CARDIOLIPIN ANTIBODY EA IG,86147,CPT,302,RC,,,,outpatient,,,123,12.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,22.64,22.64,22.64,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,72.86,42.34,163.68,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,50.06,50.06,137.76,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,25.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,53.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,26.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,22.64,22.64,22.64,31,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,25.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,26.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,54.99,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,25.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,25.45,448,,facility
FLOWCYTOMETRY/TC ADD-ON,88185,CPT,311,RC,,,,outpatient,,,15,1.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,456.96,430.08,1705.1,168,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,52.8,,399.84,399.84,2815.68,17,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,1759.8,1759.8,1759.8,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.72,18.35,330.3,23,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,53.55,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",53.55,448,,facility
ASSAY OF CRYOGLOBULIN,82595,CPT,301,RC,,,,outpatient,,,47.5,4.75,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.75,5.75,5.75,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,38.54,38.54,38.54,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,13.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.75,5.75,5.75,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.97,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,6.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,6.47,448,,facility
HEPATITIS B SURFACE AG IA,87340,CPT,306,RC,,,,outpatient,,,25,2.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9.19,9.19,9.19,137,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,51.92,51.92,51.92,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,46.46,29.57,140.35,57,percent of total billed charges,,,33.6,,46.46,29.57,46.46,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,29.57,29.57,29.92,75,percent of total billed charges,,,34.6,,34.67,12.1,42.83,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,21.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,44,44,44.13,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,9.19,9.19,9.19,1 through 10,percent of total billed charges,,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9.19,9.19,9.19,421,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.31,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,10.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,10.33,448,,facility
DRUG TEST PRSMV CHEM ANLYZR,80307,CPT,301,RC,,,,outpatient,,,210,21,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,55.27,55.27,55.27,34,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,62.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,62.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,171.87,131.38,223.26,14,percent of total billed charges,,,33.6,,206.45,131.38,223.26,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,131.38,102.04,131.38,13,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,62.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,129.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,65.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,55.27,55.27,55.27,332,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,62.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,65.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,125.7,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,63.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,62.14,448,,facility
ASSAY ACID PHOSPHATASE,84060,CPT,301,RC,,,,outpatient,,,28.6,2.86,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,7.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,15.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,7.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.96,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,7.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,7.64,448,,facility
TRICHOMONAS VAGINALIS AMPLIF,87661,CPT,306,RC,,,,outpatient,,,259,25.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,57,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,127.44,127.44,127.44,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,114.05,72.58,123.34,1 through 10,percent of total billed charges,,,33.6,,28.9,28.9,114.05,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,72.58,28.9,73.22,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,91,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
ASSAY OF TOTAL TESTOSTERONE,84403,CPT,301,RC,,,,outpatient,,,63,6.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,22.96,20,22.96,75,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,44.84,11.8,294.41,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,35.9,10.56,263.47,33,percent of total billed charges,,,33.6,,40.13,25.54,169.16,16,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,25.54,6.72,167.66,56,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,25.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,53.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,27.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,38,38,38,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,4.2,4.2,4.2,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,22.96,20,22.96,116,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,25.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,27.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,55.77,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,26.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,25.81,448,,facility
QUANTITATIVE ASSAY DRUG,80299,CPT,301,RC,,,,outpatient,,,45.9,4.59,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,13,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,174.64,174.64,174.64,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,171.6,171.6,171.6,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,374.52,374.52,374.52,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.62,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.64,448,,facility
QUANTITATIVE ASSAY DRUG,80299,CPT,301,RC,,,,outpatient,,,94.5,9.45,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,13,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,174.64,174.64,174.64,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,171.6,171.6,171.6,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,374.52,374.52,374.52,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.62,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.64,448,,facility
ASSAY OF MANGANESE,83785,CPT,301,RC,,,,outpatient,,,68.65,6.87,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,26.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,55.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,28.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,23.7,23.7,23.7,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,26.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,28.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,53.15,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,27.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,26.65,448,,facility
ASSAY OF MYOGLOBIN,83874,CPT,301,RC,,,,outpatient,,,55,5.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.49,11.49,11.49,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.91,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.92,448,,facility
TRANSFERASE (AST) (SGOT),84450,CPT,301,RC,,,,outpatient,,,34,3.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.61,4.61,4.61,56,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,23.6,23.6,23.6,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,231.83,21.12,231.83,76,percent of total billed charges,,,33.6,,136.42,13.44,231.83,18,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,136.42,13.44,137.63,57,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,10.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,203,20,203,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,8.4,8.4,8.4,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.61,4.61,4.61,642,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.18,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.18,448,,facility
COL CHROMOTOGRAPHY QUAL/QUAN,82542,CPT,301,RC,,,,outpatient,,,487,48.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,21.43,21.43,21.43,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,435.07,435.07,435.07,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,24.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,50.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,25.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,21.43,21.43,21.43,15,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,24.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,25.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.16,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,24.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,24.09,448,,facility
MOPATH PROCEDURE LEVEL 7,81406,CPT,310,RC,,,,outpatient,,,1060,106,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,282.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,282.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,291.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,282.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,591.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,299.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,282.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,299.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,495.04,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,288.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,282.88,591.22,,facility
ASSAY OF ACTH,82024,CPT,301,RC,,,,outpatient,,,35,3.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,34.35,34.35,34.35,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,39.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,66.53,24.82,71.95,1 through 10,percent of total billed charges,,,33.6,,42.34,42.34,42.34,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,32.88,32.88,32.88,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,38.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,80.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,40.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,23.5,23.5,23.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,34.35,34.35,34.35,14,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,38.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,40.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.44,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,39.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,38.62,448,,facility
SYPHILIS TEST NON-TREP QUAL,86592,CPT,302,RC,,,,outpatient,,,17,1.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.8,3.8,3.8,262,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,28.8,3.16,28.8,20,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,26.55,26.4,79.65,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,28.8,28.8,28.8,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,23.76,15.12,23.76,39,percent of total billed charges,,,33.6,,15.17,15.12,45.36,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,15.12,15.12,15.17,34,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,8.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,22.38,22.38,22.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.8,3.8,3.8,282,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.22,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,4.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,4.27,448,,facility
ASSAY OF THEOPHYLLINE,80198,CPT,301,RC,,,,outpatient,,,42,4.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,29.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.56,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.14,448,,facility
LEGIONELLA ANTIBODY,86713,CPT,302,RC,,,,outpatient,,,50,5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,31.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,33.06,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,15.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,15.3,448,,facility
MOPATH PROCEDURE LEVEL 9,81408,CPT,310,RC,,,,outpatient,,,725,72.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2000,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2000,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2060,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2000,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,4180,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2120,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2000,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2120,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3500,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,2040,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,4180,,facility
FLUORESCENT ANTIBODY TITER,86256,CPT,302,RC,,,,outpatient,,,63.65,6.37,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.72,10.72,10.72,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.04,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.05,448,,facility
COLLECT SWEAT FOR TEST,89230,CPT,300,RC,,,,outpatient,,,56,5.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,46.88,46,46.88,15,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,69.6,69.6,69.76,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,49.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,49.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,51.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,49.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,104.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,52.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,2.41,2.41,2.47,19,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,49.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,52.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,78.23,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,50.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,49.87,448,,facility
HEARING LOSS SEQUENCE ANALYS,81430,CPT,310,RC,,,,outpatient,,,787.5,78.75,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1625,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1625,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1673.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1625,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3396.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1722.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1625,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1722.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2843.75,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1657.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3396.25,,facility
HISTOPLASMA CAPSUL AG IA,87385,CPT,306,RC,,,,outpatient,,,224,22.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,126.26,126.26,126.26,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,225.98,225.98,225.98,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.79,11.79,13.25,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.9,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.25,448,,facility
ANTINUCLEAR ANTIBODIES,86038,CPT,302,RC,,,,outpatient,,,123,12.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.75,10.75,10.75,34,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,148.09,148.09,148.09,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,84.34,29.04,132.53,14,percent of total billed charges,,,33.6,,84.34,18.48,127.78,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,84.34,84.34,85.09,12,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,11.55,11.55,11.55,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.75,10.75,10.75,126,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.11,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.09,448,,facility
NUCLEAR ANTIGEN ANTIBODY,86235,CPT,302,RC,,,,outpatient,,,41,4.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13,12.5,15.95,11,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,54.91,4.37,90.29,43,percent of total billed charges,,,33.6,,4.37,4.37,53.09,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,22.18,4.24,83.33,13,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,37.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.95,13,15.95,54,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.75,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.93,448,,facility
DRUG TEST PRSMV CHEM ANLYZR,80307,CPT,301,RC,,,,outpatient,,,107,10.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,55.27,55.27,55.27,34,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,62.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,62.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,171.87,131.38,223.26,14,percent of total billed charges,,,33.6,,206.45,131.38,223.26,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,131.38,102.04,131.38,13,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,62.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,129.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,65.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,55.27,55.27,55.27,332,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,62.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,65.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,125.7,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,63.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,62.14,448,,facility
GIARDIA LAMBLIA ANTIBODY,86674,CPT,302,RC,,,,outpatient,,,60,6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,30.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,31.8,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,15.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.72,448,,facility
CLOT FACTOR X STUART-POWER,85260,CPT,305,RC,,,,outpatient,,,315,31.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,37.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.92,0.22,15.92,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.68,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.9,448,,facility
DRUG SCREEN QUANT ZONISAMIDE,80203,CPT,301,RC,,,,outpatient,,,65.75,6.58,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.79,11.79,11.79,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.63,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.25,448,,facility
OPIOIDS & OPIATE ANALOGS 1/2,80362,CPT,301,RC,,,,outpatient,,,63,6.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
ASSAY OF CITRATE,82507,CPT,301,RC,,,,outpatient,,,122,12.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,27.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,58.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,29.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,27.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,29.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,60.08,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,28.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,27.8,448,,facility
CANDIDA ANTIBODY,86628,CPT,302,RC,,,,outpatient,,,62,6.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.94,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.01,448,,facility
COMPLEMENT TOTAL (CH50),86162,CPT,302,RC,,,,outpatient,,,62,6.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,36.62,36.62,36.62,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,20.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,42.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,21.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,18.07,18.07,18.07,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,20.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,21.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,43.91,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,20.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,20.32,448,,facility
DNA/RNA SEQUENCING,87153,CPT,306,RC,,,,outpatient,,,355,35.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,102.61,102.61,102.61,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,115.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,115.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,118.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,385.39,385.39,385.39,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,115.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,241.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,122.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,115.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,122.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,249.24,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,117.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,115.36,448,,facility
CLOT FACTOR VIII MULTIMETRIC,85247,CPT,305,RC,,,,outpatient,,,225,22.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,23.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,47.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,24.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,20.4,20.4,20.4,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,24.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,49.56,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,23.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,22.94,448,,facility
CLOT FACTOR IX PTC/CHRSTMAS,85250,CPT,305,RC,,,,outpatient,,,40,4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.94,16.94,16.94,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,76.03,48.38,76.03,1 through 10,percent of total billed charges,,,33.6,,48.38,48.38,48.38,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,39.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,20.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,72,72,72,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.94,16.94,16.94,24,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,20.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,41.14,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,19.04,448,,facility
MOPATH PROCEDURE LEVEL 2,81401,CPT,310,RC,,,,outpatient,,,180,18,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,121.86,121.86,121.86,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,137,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,137,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,141.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,137,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,286.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,145.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,137,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,145.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,239.75,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,139.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,137,448,,facility
DETECT AGENT NOS DNA AMP,87798,CPT,306,RC,,,,outpatient,,,237.9,23.79,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,110.88,110.88,174.24,1 through 10,percent of total billed charges,,,33.6,,244.27,244.27,244.27,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,96.77,32.38,119.79,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,38.9,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
RUBEOLA ANTIBODY,86765,CPT,302,RC,,,,outpatient,,,29.14,2.91,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.46,11.46,11.46,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,22.18,22.18,83.95,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,20.68,20.68,20.68,1 through 10,percent of total billed charges,,,34.6,,61.35,61.35,61.35,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,26.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,44,44,44,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.46,11.46,11.46,18,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.88,448,,facility
RBC LEUKOCYTES REDUCED,P9016,HCPCS,390,RC,,,,outpatient,,,142,14.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,169.72,167.88,335.75,32,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,1502.72,1502.72,1502.72,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,184,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,184,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,189.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,1340.71,1239.74,2479.49,1 through 10,percent of total billed charges,,,33.6,,1239.74,788.93,1340.71,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,795.97,795.97,795.97,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,184,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,384.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,195.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,4930.8,4930.8,4930.8,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,136.54,136.54,273.08,30,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,184,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,195.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,107,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,187.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,107,448,,facility
BLOOD GASES ANY COMBINATION,82803,CPT,301,RC,,,,outpatient,,,39,3.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,23.19,23.19,23.19,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,182.16,115.92,197,26,percent of total billed charges,,,33.6,,115.92,107.14,115.92,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,115.92,89.84,228.59,16,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,26.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,54.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,27.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,172.5,172.5,172.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,23.19,23.19,23.19,245,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,26.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,27.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,45.62,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,26.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,26.07,448,,facility
IMMUNOASSAY QUANT NOS NONAB,83520,CPT,301,RC,,,,outpatient,,,95.65,9.57,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,36,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,66.08,66.08,66.08,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,41.18,24.82,318.38,1 through 10,percent of total billed charges,,,33.6,,37.63,37.63,96.43,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,33.6,23.18,176.4,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,36.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,87,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.22,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.27,448,,facility
ORGANIC ACID SINGLE QUANT,83921,CPT,301,RC,,,,outpatient,,,61.1,6.11,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,18.87,18.87,18.87,11,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,60.72,38.64,203.28,1 through 10,percent of total billed charges,,,33.6,,129.36,129.36,129.36,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,38.64,38.64,38.9,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,21.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,44.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,57.38,57.38,57.38,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,18.87,18.87,18.87,21,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,21.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,37.12,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,21.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,21.21,448,,facility
NUCLEAR ANTIGEN ANTIBODY,86235,CPT,302,RC,,,,outpatient,,,167,16.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13,12.5,15.95,11,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,54.91,4.37,90.29,43,percent of total billed charges,,,33.6,,4.37,4.37,53.09,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,22.18,4.24,83.33,13,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,37.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.95,13,15.95,54,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.75,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.93,448,,facility
ORGANIC ACIDS QUAL EACH,83919,CPT,301,RC,,,,outpatient,,,105,10.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,14.63,14.63,14.63,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,34.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,14.63,14.63,14.63,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.54,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,16.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,16.45,448,,facility
BLOOD TYPING SEROLOGIC ABO,86900,CPT,302,RC,,,,outpatient,,,6,0.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,113.1,113.1,127.33,523,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,207.68,21.24,207.68,13,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,131.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,118.27,18.88,200.99,116,percent of total billed charges,,,33.6,,118.27,18.88,118.27,44,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,118.27,12.1,134.11,78,percent of total billed charges,,,34.6,,130.24,127.78,134.11,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,266.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,134.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,176,17.88,176,13,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,73.92,7.56,73.92,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,2.66,2.66,2.66,1 through 10,percent of total billed charges,,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,2.66,2.66,2.66,824,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,134.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.46,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,129.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,6.46,448,,facility
LEUKOCYTE ASSESSMENT FECAL,89055,CPT,309,RC,,,,outpatient,,,12,1.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,8.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.22,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,4.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,4.27,448,,facility
DETECT AGENT NOS DNA AMP,87798,CPT,306,RC,,,,outpatient,,,426,42.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,110.88,110.88,174.24,1 through 10,percent of total billed charges,,,33.6,,244.27,244.27,244.27,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,96.77,32.38,119.79,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,38.9,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
HERPES SIMPLEX TYPE 1 TEST,86695,CPT,302,RC,,,,outpatient,,,115,11.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.73,11.73,11.73,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,20.59,20.59,42.71,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,13.1,13.1,13.1,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.73,11.73,11.73,15,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.49,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.19,448,,facility
BENZODIAZEPINES 13 OR MORE,80347,CPT,301,RC,,,,outpatient,,,270,27,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
COLLAGEN CROSSLINKS,82523,CPT,301,RC,,,,outpatient,,,51.9,5.19,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,39.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.62,16.62,16.62,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,40.37,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.68,448,,facility
DETECT AGENT NOS DNA AMP,87798,CPT,306,RC,,,,outpatient,,,31.75,3.18,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,110.88,110.88,174.24,1 through 10,percent of total billed charges,,,33.6,,244.27,244.27,244.27,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,96.77,32.38,119.79,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,38.9,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
THROMBIN TIME PLASMA,85670,CPT,305,RC,,,,outpatient,,,42,4.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,12.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.46,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.77,448,,facility
IMMUNOASSAY NONANTIBODY,83516,CPT,301,RC,,,,outpatient,,,163.5,16.35,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9,9,10.26,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,4.75,4.75,218.59,30,percent of total billed charges,,,33.6,,3.02,3.02,175.39,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,3.02,3.02,211.68,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,24.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,23.5,23.5,23.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9,9,10.26,51,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.92,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,11.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.53,448,,facility
SMEAR SPECIAL STAIN,87207,CPT,306,RC,,,,outpatient,,,12,1.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,39.53,39.53,574.66,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,12.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.95,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,6.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.99,448,,facility
TISSUE CULTURE LYMPHOCYTE,88230,CPT,311,RC,,,,outpatient,,,209,20.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,103.62,103.62,103.62,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,588.16,588.16,588.16,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,116.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,116.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,119.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,485.23,47.52,485.23,1 through 10,percent of total billed charges,,,33.6,,308.78,308.78,485.23,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,308.78,265.78,308.78,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,116.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,243.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,123.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,103.62,103.62,103.62,12,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,116.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,123.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,251.69,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,118.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,116.49,448,,facility
LEGION PNEUMO DNA AMP PROB,87541,CPT,306,RC,,,,outpatient,,,93,9.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
MSH6 GENE FULL SEQ,81298,CPT,310,RC,,,,outpatient,,,250,25,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,641.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,641.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,661.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,641.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1341.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,680.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,641.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,680.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1123.24,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,654.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1341.47,,facility
SC STD DISK METHOD PER PLATE,87184,CPT,306,RC,,,,outpatient,,,63.75,6.38,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,7.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,15.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,7.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,6.65,6.65,6.65,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,7.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,7.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.89,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,7.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,7.48,448,,facility
TOXOPLASMA ANTIBODY,86777,CPT,302,RC,,,,outpatient,,,151,15.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.8,12.8,12.8,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,64.42,64.42,64.42,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,30.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.8,12.8,12.8,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,31.1,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.39,448,,facility
T CELLS TOTAL COUNT,86359,CPT,302,RC,,,,outpatient,,,173,17.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,33.56,33.56,33.56,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,37.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,37.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,82.68,82.68,82.68,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,78.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,39.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,33.56,33.56,33.56,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,39.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,81.52,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,38.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,37.73,448,,facility
HEMOGLOBIN FETAL,85461,CPT,305,RC,,,,outpatient,,,18,1.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,9.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,19.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,9.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,9.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,9.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.38,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,9.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,9.36,448,,facility
ACETYLCHOLN RCPTR BLCKG ANTB,86042,CPT,302,RC,,,,outpatient,,,129,12.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.37,16.37,16.37,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.2,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.4,448,,facility
FLUORESCENT ANTIBODY TITER,86256,CPT,302,RC,,,,outpatient,,,153,15.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.72,10.72,10.72,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.04,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.05,448,,facility
IMMUNOASSAY INFECTIOUS AGENT,86317,CPT,302,RC,,,,outpatient,,,85.5,8.55,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.33,13.33,13.33,86,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,59,59,59,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,52.8,26.54,52.8,41,percent of total billed charges,,,33.6,,52.8,33.6,52.8,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,33.6,33.6,33.73,52,percent of total billed charges,,,34.6,,218.53,218.53,218.53,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,31.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,50,50,50,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.33,13.33,13.33,209,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.38,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,15.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.99,448,,facility
ENCEPHALTIS EAST EQNE ANBDY,86652,CPT,302,RC,,,,outpatient,,,41.6,4.16,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.49,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.19,448,,facility
FLUORESCENT ANTIBODY SCREEN,86255,CPT,302,RC,,,,outpatient,,,66.75,6.68,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.72,10.72,10.72,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,45.41,28.9,1068.67,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,28.9,28.9,28.9,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.72,10.72,10.72,19,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.04,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.05,448,,facility
PROTHROMBIN TIME,85610,CPT,305,RC,,,,outpatient,,,37,3.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.82,3.82,3.82,148,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,25.6,25.6,68.48,85,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,63.13,63.13,63.13,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,35.95,16.37,61.1,101,percent of total billed charges,,,33.6,,21.12,13.44,56.5,20,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,13.56,13.44,36.27,76,percent of total billed charges,,,34.6,,38.84,38.84,40.77,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,8.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,53.5,20,141,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,22.47,8.4,22.47,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.82,3.82,3.82,801,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.49,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,4.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,4.29,448,,facility
ASSAY OF PHENYTOIN TOTAL,80185,CPT,301,RC,,,,outpatient,,,22,2.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,70.22,70.22,70.22,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,44.69,44.69,44.69,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.79,11.79,11.79,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.63,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.25,448,,facility
IMMUNOASSAY TUMOR OTHER,86316,CPT,302,RC,,,,outpatient,,,165,16.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,18.51,18.51,18.51,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,76.03,32.21,76.03,1 through 10,percent of total billed charges,,,33.6,,48.38,48.38,48.38,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,20.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,43.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,18.51,18.51,18.51,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,20.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,44.98,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,21.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,20.81,448,,facility
PROTEIN WESTERN BLOT TEST,84182,CPT,301,RC,,,,outpatient,,,388,38.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,217.54,217.54,217.54,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,29.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,61.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,30.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,25.98,25.98,25.98,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,29.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,30.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,51.12,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,29.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,29.21,448,,facility
QUANTITATIVE ASSAY DRUG,80299,CPT,301,RC,,,,outpatient,,,154.5,15.45,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,13,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,174.64,174.64,174.64,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,171.6,171.6,171.6,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,374.52,374.52,374.52,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.62,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.64,448,,facility
M. GENITALIUM AMP PROBE,87563,CPT,306,RC,,,,outpatient,,,129,12.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,61.41,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
BRAF GENE,81210,CPT,310,RC,,,,outpatient,,,543,54.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,156.02,156.02,156.02,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,175.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,175.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,180.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,175.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,366.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,185.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,156.02,156.02,156.02,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,175.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,185.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,306.95,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,178.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,175.4,448,,facility
ASSAY OF LIDOCAINE,80176,CPT,301,RC,,,,outpatient,,,20.5,2.05,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,30.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,31.75,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.69,448,,facility
URINALYSIS AUTO W/O SCOPE,81003,CPT,307,RC,,,,outpatient,,,7,0.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,2,2,2,141,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,148.09,148.09,148.09,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,143.32,15.84,143.32,137,percent of total billed charges,,,33.6,,84.34,9.5,143.32,35,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,84.34,10.08,85.09,61,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,4.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,125.5,125.5,125.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,251,251,251,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,2,2,2,1 through 10,percent of total billed charges,,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,2,2,2,997,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.85,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,2.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,2.25,448,,facility
PROTOZOA ANTIBODY NOS,86753,CPT,302,RC,,,,outpatient,,,84,8.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.02,11.02,11.02,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,98.11,98.11,154.18,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,96.77,32.38,106,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.02,11.02,11.02,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.76,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.39,448,,facility
PLATELET PHERES LEUKOREDUCED,P9035,HCPCS,390,RC,,,,outpatient,,,198,19.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,509.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,509.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,524.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,509.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1063.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,539.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,509.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,539.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,107,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,519.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,107,1063.98,,facility
ORGANIC ACID SINGLE QUANT,83921,CPT,301,RC,,,,outpatient,,,112.5,11.25,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,18.87,18.87,18.87,11,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,60.72,38.64,203.28,1 through 10,percent of total billed charges,,,33.6,,129.36,129.36,129.36,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,38.64,38.64,38.9,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,21.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,44.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,57.38,57.38,57.38,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,18.87,18.87,18.87,21,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,21.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,37.12,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,21.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,21.21,448,,facility
SMEAR GRAM STAIN,87205,CPT,306,RC,,,,outpatient,,,6,0.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.8,3.8,3.8,30,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,180.48,3.16,180.48,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,166.38,166.38,166.38,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,94.75,94.75,148.9,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,94.75,94.75,95.6,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,8.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.8,3.8,3.8,139,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.22,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,4.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,4.27,448,,facility
HSV DNA AMP PROBE,87529,CPT,306,RC,,,,outpatient,,,31.75,3.18,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,244.61,244.61,244.61,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
HEXAGNAL PHOSPH PLTLT NEUTRL,85598,CPT,305,RC,,,,outpatient,,,50,5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.99,15.99,15.99,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,168.32,168.32,168.32,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,37.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.98,448,,facility
MOPATH PROCEDURE LEVEL 2,81401,CPT,310,RC,,,,outpatient,,,551,55.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,121.86,121.86,121.86,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,137,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,137,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,141.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,137,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,286.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,145.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,137,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,145.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,239.75,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,139.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,137,448,,facility
HEPATITIS BE AG IA,87350,CPT,306,RC,,,,outpatient,,,19.3,1.93,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.26,10.26,10.26,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,19.14,19.14,19.14,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,12.1,12.1,12.29,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,24.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.26,10.26,10.26,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.9,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,11.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.53,448,,facility
PHOSPHOLIPID PLTLT NEUTRALIZ,85597,CPT,305,RC,,,,outpatient,,,103,10.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,37.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.98,448,,facility
BRUCELLA ANTIBODY,86622,CPT,302,RC,,,,outpatient,,,88,8.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,18.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,9.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,7.94,7.94,7.94,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,9.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.3,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,9.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,8.93,448,,facility
ASSAY OF OSTEOCALCIN,83937,CPT,301,RC,,,,outpatient,,,80,8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,29.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,62.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,31.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,26.55,26.55,26.55,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,29.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,31.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,64.49,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,30.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,29.85,448,,facility
MOPATH PROCEDURE LEVEL 4,81403,CPT,310,RC,,,,outpatient,,,77,7.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,185.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,185.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,190.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,322.39,322.39,322.39,1 through 10,percent of total billed charges,,,34.6,,397.12,397.12,397.12,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,185.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,387.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,196.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,185.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,196.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,324.1,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,188.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,185.2,448,,facility
ASSAY OF SERUM ALBUMIN,82040,CPT,301,RC,,,,outpatient,,,5,0.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.4,4.4,4.4,46,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,14.75,9.9,14.75,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,85,85,85,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,48.53,13.2,48.54,74,percent of total billed charges,,,33.6,,28.56,8.4,48.53,18,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,28.56,8.4,28.82,49,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,10.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,42.5,12.5,42.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,5.25,5.25,5.25,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.4,4.4,4.4,515,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.69,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,4.95,448,,facility
ASSAY OF URINE CREATININE,82570,CPT,301,RC,,,,outpatient,,,71,7.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.61,4.61,4.61,213,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,71.39,41.89,142.78,14,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,37.49,23.86,74.98,60,percent of total billed charges,,,33.6,,37.49,23.85,81.31,18,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,24.07,23.86,47.71,75,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,10.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,60.5,4.61,151,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,14.91,14.91,25.41,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,85.58,85.58,85.58,1 through 10,percent of total billed charges,,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.61,4.61,4.61,636,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.18,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.18,448,,facility
AUTOPSY (NECROPSY) COMPLETE,88029,CPT,310,RC,,,,outpatient,,,3000,300,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,389.97,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,389.97,448,,facility
URINALYSIS AUTO W/O SCOPE,81003,CPT,307,RC,,,,outpatient,,,9,0.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,2,2,2,141,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,148.09,148.09,148.09,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,143.32,15.84,143.32,137,percent of total billed charges,,,33.6,,84.34,9.5,143.32,35,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,84.34,10.08,85.09,61,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,4.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,125.5,125.5,125.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,251,251,251,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,2,2,2,1 through 10,percent of total billed charges,,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,2,2,2,997,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.85,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,2.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,2.25,448,,facility
BRAF GENE,81210,CPT,310,RC,,,,outpatient,,,366,36.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,156.02,156.02,156.02,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,175.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,175.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,180.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,175.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,366.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,185.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,156.02,156.02,156.02,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,175.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,185.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,306.95,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,178.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,175.4,448,,facility
CLOT FACTOR VIII VW RISTOCTN,85245,CPT,305,RC,,,,outpatient,,,120,12,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,20.4,20.4,20.4,41,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,23.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,79.2,50.4,79.2,1 through 10,percent of total billed charges,,,33.6,,50.4,50.4,50.4,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,50.4,50.4,50.85,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,47.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,24.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,75,75,75,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,20.4,20.4,20.4,66,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,24.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,49.56,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,23.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,22.94,448,,facility
COMPLEMENT ANTIGEN,86160,CPT,302,RC,,,,outpatient,,,90,9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.67,10.67,10.67,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,87.32,87.32,87.32,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,78.14,49.73,270.86,17,percent of total billed charges,,,33.6,,49.73,49.73,172.37,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,49.73,29.23,50.32,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,256.5,256.5,256.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.67,10.67,10.67,61,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.92,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12,448,,facility
IMMUNOASSAY TUMOR CA 15-3,86300,CPT,302,RC,,,,outpatient,,,30.4,3.04,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,204.29,204.29,204.29,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,20.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,43.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,18.51,18.51,18.51,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,20.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,44.98,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,21.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,20.81,448,,facility
FMR1 GEN ALY DETC ABNL ALLEL,81243,CPT,310,RC,,,,outpatient,,,323,32.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,57.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,57.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,58.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,57.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,119.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,60.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,50.74,50.74,50.74,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,57.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,60.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,99.82,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,58.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,57.04,448,,facility
CRYOPRECIPITATE EACH UNIT,P9012,HCPCS,390,RC,,,,outpatient,,,45.5,4.55,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,71.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,71.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,73.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,536.98,536.98,536.98,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,71.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,149.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,75.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,71.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,75.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,107,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,73.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,71.6,448,,facility
MSH6 GENE FULL SEQ,81298,CPT,310,RC,,,,outpatient,,,400,40,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,641.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,641.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,661.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,641.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1341.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,680.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,641.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,680.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1123.24,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,654.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1341.47,,facility
EHRLICHIA ANTIBODY,86666,CPT,302,RC,,,,outpatient,,,103,10.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,7.53,7.53,7.53,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,21.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9.05,9.05,9.05,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.98,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,10.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,10.18,448,,facility
CLOT INHIBIT PROT C ANTIGEN,85302,CPT,305,RC,,,,outpatient,,,43,4.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.68,10.68,10.68,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,90.05,90.05,90.05,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.68,10.68,81.75,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.95,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.01,448,,facility
RBC PRETX INCUBATJ W/CHEMICL,86970,CPT,302,RC,,,,outpatient,,,250,25,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,56.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,56.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,58.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,145.56,145.56,145.56,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,56.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,118,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,59.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,56.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,59.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,55.65,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,57.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,55.65,448,,facility
DETECT AGENT NOS DNA QUANT,87799,CPT,306,RC,,,,outpatient,,,370,37,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,38.11,38.11,38.11,39,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,44.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,200.64,91.44,597.79,1 through 10,percent of total billed charges,,,33.6,,203.95,203.95,203.95,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,231.27,203.95,231.27,11,percent of total billed charges,,,34.6,,220.34,220.34,231.27,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,89.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,45.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,38.11,38.11,38.11,221,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,45.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,92.54,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,43.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,42.84,448,,facility
HEMOGLOBIN,85018,CPT,305,RC,,,,outpatient,,,2.19,0.22,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,2.11,2.11,2.11,20,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,17.92,17.92,72.32,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,3.32,3.32,16.52,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,59.66,14.92,94.03,1 through 10,percent of total billed charges,,,33.6,,14.78,14.78,14.92,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,9.41,9.41,37.97,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,4.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,14,14,14,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,2.11,2.11,2.11,57,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.13,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,2.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,2.37,448,,facility
ASSAY OF BLOOD FATTY ACIDS,82725,CPT,301,RC,,,,outpatient,,,38.7,3.87,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,39.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.85,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.77,448,,facility
QUANTITATIVE ASSAY DRUG,80299,CPT,301,RC,,,,outpatient,,,42.1,4.21,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,13,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,174.64,174.64,174.64,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,171.6,171.6,171.6,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,374.52,374.52,374.52,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.62,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.64,448,,facility
ASSAY OF ESTRONE,82679,CPT,301,RC,,,,outpatient,,,52,5.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,24.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,52.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,26.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,24.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,26.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,53.92,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,25.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,24.95,448,,facility
PLATELET ANTIBODIES,86022,CPT,302,RC,,,,outpatient,,,95,9.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.34,16.34,16.34,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,39.69,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.37,448,,facility
ASSAY OF URINE/UREA-N,84540,CPT,301,RC,,,,outpatient,,,44,4.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,91.87,91.87,91.87,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,11.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,135.5,135.5,135.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.95,4.95,4.95,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.26,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.56,448,,facility
URINALYSIS AUTO W/SCOPE,81001,CPT,307,RC,,,,outpatient,,,6,0.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,2.82,2.82,2.82,418,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,229.76,25.6,256,88,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,211.81,23.6,236,14,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,204.99,21.12,228.4,143,percent of total billed charges,,,33.6,,134.4,21.12,189.55,25,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,121.7,13.44,135.6,151,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,6.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,179.5,20,200,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,8.4,8.4,84,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,2.82,2.82,2.82,1909,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.86,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,3.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,3.17,448,,facility
CELL FUNCTION ASSAY W/STIM,86352,CPT,302,RC,,,,outpatient,,,46,4.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,135.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,135.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,139.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,210.52,210.52,210.52,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,135.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,283.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,144.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,120.85,120.85,120.85,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,135.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,144.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,293.53,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,138.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,135.86,448,,facility
ANTINUCLEAR ANTIBODIES,86038,CPT,302,RC,,,,outpatient,,,139,13.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.75,10.75,10.75,34,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,148.09,148.09,148.09,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,84.34,29.04,132.53,14,percent of total billed charges,,,33.6,,84.34,18.48,127.78,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,84.34,84.34,85.09,12,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,11.55,11.55,11.55,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.75,10.75,10.75,126,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.11,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.09,448,,facility
GABAPENTIN NON-BLOOD,80355,CPT,301,RC,,,,outpatient,,,40,4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
DETECTION TEST BY NUCLEIC ACID FOR HIV-1 VIRUS; QUANTIFICATION,87536,CPT,0306,RC,,,,outpatient,,,195,19.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,75.7,75.7,75.7,61,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,115.05,115.05,369.93,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,124.8,124.8,124.8,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,85.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,85.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,87.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,102.96,65.52,102.96,24,percent of total billed charges,,,33.6,,102.96,65.52,331.06,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,65.52,65.52,66.11,15,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,85.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,177.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,90.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,97.5,97.5,97.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,75.7,75.7,75.7,201,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,85.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,90.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,183.86,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,86.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,85.1,448,,facility
UNLISTED MOLECULAR PATHOLOGY,81479,CPT,310,RC,,,,outpatient,,,1845,184.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,561.56,561.56,561.56,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,32.5,32.5,3071.5,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
OPIOID &OPIATE ANALOG 5/MORE,80364,CPT,301,RC,,,,outpatient,,,40,4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
ASSAY OF LIPASE,83690,CPT,301,RC,,,,outpatient,,,8,0.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,6.13,6.13,6.13,44,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,81.65,42.15,81.65,67,percent of total billed charges,,,33.6,,48.05,19.01,48.05,11,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,48.05,37.29,48.05,74,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,14.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,7.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,18,18,71.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,6.13,6.13,6.13,696,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,7.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.89,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,7.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,6.89,448,,facility
ASSAY OF HOMOVANILLIC ACID,83150,CPT,301,RC,,,,outpatient,,,38.4,3.84,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,23.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,46.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,23.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.93,19.93,19.93,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,23.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,41.81,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,22.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,22.41,448,,facility
GENETIC TSTG SEVERE INH COND,81443,CPT,310,RC,,,,outpatient,,,3027,302.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2448.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2448.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2522.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2448.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,5117.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2595.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2448.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2595.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4284.98,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,2497.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,5117.49,,facility
ASSAY ANTI-MULLERIAN HORM,82166,CPT,301,RC,,,,outpatient,,,205,20.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,39.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,98.74,98.74,118.27,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,62.83,62.83,63.39,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,38.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,80.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,40.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,93.5,93.5,93.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,38.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,40.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,67.59,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,39.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,38.62,448,,facility
DETECT AGENT NOS DNA AMP,87798,CPT,306,RC,,,,outpatient,,,141.25,14.13,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,110.88,110.88,174.24,1 through 10,percent of total billed charges,,,33.6,,244.27,244.27,244.27,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,96.77,32.38,119.79,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,38.9,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
ASSAY OF PROCAINAMIDE,80192,CPT,301,RC,,,,outpatient,,,48,4.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,35.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.19,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,16.75,448,,facility
HISTOPLASMA ANTIBODY,86698,CPT,302,RC,,,,outpatient,,,115,11.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.27,12.27,12.27,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,28.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.27,12.27,12.27,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.79,448,,facility
CLOT INHIBIT PROT C ACTIVITY,85303,CPT,305,RC,,,,outpatient,,,45,4.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.31,12.31,12.31,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,40.66,25.87,40.66,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,28.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.31,12.31,12.31,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.89,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.84,448,,facility
DRUG TEST PRSMV CHEM ANLYZR,80307,CPT,301,RC,,,,outpatient,,,34,3.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,55.27,55.27,55.27,34,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,62.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,62.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,171.87,131.38,223.26,14,percent of total billed charges,,,33.6,,206.45,131.38,223.26,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,131.38,102.04,131.38,13,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,62.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,129.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,65.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,55.27,55.27,55.27,332,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,62.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,65.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,125.7,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,63.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,62.14,448,,facility
HHV-6 DNA QUANT,87533,CPT,306,RC,,,,outpatient,,,265,26.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,37.14,37.14,37.14,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,41.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,41.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,43.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,41.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,87.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,44.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,37.14,37.14,37.14,24,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,41.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,44.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,90.21,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,42.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,41.76,448,,facility
ASSAY OF METANEPHRINES,83835,CPT,301,RC,,,,outpatient,,,49.25,4.93,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.07,15.07,15.07,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,32.45,32.45,32.45,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,35.28,35.28,35.28,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,35.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.07,15.07,15.07,11,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.61,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,16.94,448,,facility
IMMUNOASSAY QUANT NOS NONAB,83520,CPT,301,RC,,,,outpatient,,,117,11.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,36,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,66.08,66.08,66.08,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,41.18,24.82,318.38,1 through 10,percent of total billed charges,,,33.6,,37.63,37.63,96.43,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,33.6,23.18,176.4,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,36.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,87,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.22,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.27,448,,facility
TP53 GENE FULL GENE SEQUENCE,81351,CPT,310,RC,,,,outpatient,,,250,25,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,641.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,641.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,661.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,641.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1341.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,680.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,641.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,680.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1123.24,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,654.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1341.47,,facility
FIBRINOLYTIC ANTIPLASMIN,85410,CPT,305,RC,,,,outpatient,,,82.5,8.25,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,7.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,16.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,7.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.64,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,7.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,7.71,448,,facility
ANTINUCLEAR ANTIBODIES,86038,CPT,302,RC,,,,outpatient,,,61,6.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.75,10.75,10.75,34,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,148.09,148.09,148.09,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,84.34,29.04,132.53,14,percent of total billed charges,,,33.6,,84.34,18.48,127.78,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,84.34,84.34,85.09,12,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,11.55,11.55,11.55,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.75,10.75,10.75,126,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.11,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.09,448,,facility
THROMBOPLASTIN TIME PARTIAL,85730,CPT,305,RC,,,,outpatient,,,57,5.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.35,5.35,5.35,44,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,17.28,17.28,226.56,25,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,208.86,15.93,208.86,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,186.91,11.69,202.13,44,percent of total billed charges,,,33.6,,118.94,9.07,237.89,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,118.94,9.07,120.01,25,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,12.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,177,13.5,177,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.35,5.35,5.35,310,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.99,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,6.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,6.01,448,,facility
FLUORESCENT ANTIBODY SCREEN,86255,CPT,302,RC,,,,outpatient,,,44,4.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.72,10.72,10.72,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,45.41,28.9,1068.67,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,28.9,28.9,28.9,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.72,10.72,10.72,19,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.04,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.05,448,,facility
RBC ANTIBODY SCREEN,86850,CPT,302,RC,,,,outpatient,,,18,1.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,46.88,46,50.82,18,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,256.65,37.76,256.65,13,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,49.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,49.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,51.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,146.16,33.66,248.39,115,percent of total billed charges,,,33.6,,146.16,33.66,146.16,44,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,146.16,21.5,165.73,78,percent of total billed charges,,,34.6,,165.73,157.9,315.81,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,49.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,104.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,52.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,32,31.88,217.5,14,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,91.35,13.44,91.35,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,8.69,8.69,8.69,1 through 10,percent of total billed charges,,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,8.69,8.69,8.69,811,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,49.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,52.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.1,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,50.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.1,448,,facility
ASSAY OF URINE/UREA-N,84540,CPT,301,RC,,,,outpatient,,,19.87,1.99,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,91.87,91.87,91.87,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,11.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,135.5,135.5,135.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.95,4.95,4.95,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.26,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.56,448,,facility
BACTERIUM ANTIBODY,86609,CPT,302,RC,,,,outpatient,,,149,14.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,26.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.88,448,,facility
ANTIPSYCHOTICS NOS 1-3,80342,CPT,301,RC,,,,outpatient,,,49.45,4.95,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
HEP B CORE ANTIBODY IGM,86705,CPT,302,RC,,,,outpatient,,,16,1.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.47,10.47,10.47,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,78.08,78.08,78.08,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,64.15,64.15,64.15,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,41.19,40.99,41.19,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,24.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.47,10.47,10.47,11,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.45,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.77,448,,facility
IMMUNOASSAY NONANTIBODY,83516,CPT,301,RC,,,,outpatient,,,71,7.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9,9,10.26,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,4.75,4.75,218.59,30,percent of total billed charges,,,33.6,,3.02,3.02,175.39,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,3.02,3.02,211.68,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,24.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,23.5,23.5,23.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9,9,10.26,51,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.92,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,11.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.53,448,,facility
GLUCOSE TEST,82950,CPT,301,RC,,,,outpatient,,,14,1.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.23,4.23,4.23,314,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,37.76,34.96,37.92,33,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,34.81,34.81,34.81,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,31.15,19.82,89.04,20,percent of total billed charges,,,33.6,,19.82,19.82,139.92,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,19.82,19.82,20.09,38,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,9.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,29.63,29.5,132.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,15.07,15.07,15.07,1 through 10,percent of total billed charges,,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.23,4.23,4.23,279,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.26,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,4.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,4.75,448,,facility
DRUG SCREENING METHADONE,80358,CPT,301,RC,,,,outpatient,,,35,3.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
COL CHROMOTOGRAPHY QUAL/QUAN,82542,CPT,301,RC,,,,outpatient,,,66,6.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,21.43,21.43,21.43,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,435.07,435.07,435.07,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,24.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,50.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,25.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,21.43,21.43,21.43,15,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,24.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,25.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.16,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,24.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,24.09,448,,facility
THROMBOPLASTIN TIME PARTIAL,85730,CPT,305,RC,,,,outpatient,,,3.5,0.35,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.35,5.35,5.35,44,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,17.28,17.28,226.56,25,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,208.86,15.93,208.86,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,186.91,11.69,202.13,44,percent of total billed charges,,,33.6,,118.94,9.07,237.89,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,118.94,9.07,120.01,25,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,12.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,177,13.5,177,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.35,5.35,5.35,310,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.99,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,6.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,6.01,448,,facility
SEMEN ANAL SPERM DETECTION,89321,CPT,300,RC,,,,outpatient,,,27,2.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,17.47,17.47,17.47,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.04,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.05,448,,facility
CLOT INHIBIT PROT C ACTIVITY,85303,CPT,305,RC,,,,outpatient,,,52,5.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.31,12.31,12.31,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,40.66,25.87,40.66,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,28.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.31,12.31,12.31,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.89,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.84,448,,facility
ENCEPHALTIS ST LOUIS ANTBODY,86653,CPT,302,RC,,,,outpatient,,,41.6,4.16,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.49,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.19,448,,facility
ENCEPHALTIS WEST EQNE ANTBDY,86654,CPT,302,RC,,,,outpatient,,,43,4.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.49,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.19,448,,facility
THROMBOPLASTIN TIME PARTIAL,85730,CPT,305,RC,,,,outpatient,,,55,5.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.35,5.35,5.35,44,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,17.28,17.28,226.56,25,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,208.86,15.93,208.86,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,186.91,11.69,202.13,44,percent of total billed charges,,,33.6,,118.94,9.07,237.89,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,118.94,9.07,120.01,25,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,12.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,177,13.5,177,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.35,5.35,5.35,310,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.99,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,6.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,6.01,448,,facility
BRAF GENE,81210,CPT,310,RC,,,,outpatient,,,728,72.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,156.02,156.02,156.02,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,175.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,175.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,180.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,175.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,366.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,185.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,156.02,156.02,156.02,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,175.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,185.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,306.95,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,178.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,175.4,448,,facility
PTEN GENE DUP/DELET VARIANT,81323,CPT,310,RC,,,,outpatient,,,200,20,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,300,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,300,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,309,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,300,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,627,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,318,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,300,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,318,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,525,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,306,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,300,627,,facility
N.GONORRHOEAE DNA AMP PROB,87591,CPT,306,RC,,,,outpatient,,,196,19.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,442,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,50.15,20.65,65.49,11,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,228.48,228.48,228.48,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,37.3,18.48,58.61,60,percent of total billed charges,,,33.6,,37.3,11.76,63.38,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,28.82,11.76,37.3,69,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,42.5,17.5,55.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,23.31,23.31,23.31,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,31.21,31.21,31.21,1 through 10,percent of total billed charges,,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,796,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
MOPATH PROCEDURE LEVEL 6,81405,CPT,310,RC,,,,outpatient,,,967.5,96.75,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,301.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,301.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,310.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,301.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,629.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,319.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,301.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,319.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,527.36,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,307.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,301.35,629.82,,facility
MOPATH PROCEDURE LEVEL 6,81405,CPT,310,RC,,,,outpatient,,,181,18.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,301.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,301.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,310.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,301.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,629.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,319.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,301.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,319.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,527.36,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,307.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,301.35,629.82,,facility
HISTOPLASMA CAPSUL AG IA,87385,CPT,306,RC,,,,outpatient,,,160.5,16.05,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,126.26,126.26,126.26,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,225.98,225.98,225.98,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.79,11.79,13.25,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.9,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.25,448,,facility
WBC ANTIBODY IDENTIFICATION,86021,CPT,302,RC,,,,outpatient,,,47.5,4.75,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.39,13.39,13.39,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,20.59,13.1,38.54,1 through 10,percent of total billed charges,,,33.6,,134.11,134.11,134.11,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,13.1,13.1,13.1,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,31.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.39,13.39,13.39,23,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.53,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,15.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,15.05,448,,facility
PLATELET ANTIBODIES,86022,CPT,302,RC,,,,outpatient,,,55,5.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.34,16.34,16.34,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,39.69,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.37,448,,facility
ASSAY OF ESTRONE,82679,CPT,301,RC,,,,outpatient,,,63.25,6.33,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,24.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,52.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,26.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,24.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,26.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,53.92,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,25.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,24.95,448,,facility
ASSAY OF TOTAL TESTOSTERONE,84403,CPT,301,RC,,,,outpatient,,,43.45,4.35,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,22.96,20,22.96,75,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,44.84,11.8,294.41,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,35.9,10.56,263.47,33,percent of total billed charges,,,33.6,,40.13,25.54,169.16,16,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,25.54,6.72,167.66,56,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,25.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,53.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,27.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,38,38,38,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,4.2,4.2,4.2,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,22.96,20,22.96,116,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,25.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,27.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,55.77,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,26.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,25.81,448,,facility
SUGARS SINGLE QUANT,84378,CPT,301,RC,,,,outpatient,,,75,7.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,24.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.9,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,11.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.53,448,,facility
ENZYME CELL ACTIVITY,82657,CPT,301,RC,,,,outpatient,,,450,45,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.72,19.72,19.72,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,2094.14,2094.14,2094.14,1 through 10,percent of total billed charges,,,33.6,,762.96,762.96,762.96,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,46.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,23.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.72,19.72,19.72,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,23.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,39.01,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,22.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,22.17,448,,facility
CHLAMYDIA IGM ANTIBODY,86632,CPT,302,RC,,,,outpatient,,,100,10,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,26.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.41,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.68,448,,facility
IMMUNE COMPLEX ASSAY,86332,CPT,302,RC,,,,outpatient,,,42,4.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,24.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,50.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,25.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,24.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,25.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,52.66,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,24.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,24.37,448,,facility
ASSAY IGA/IGD/IGG/IGM EACH,82784,CPT,301,RC,,,,outpatient,,,45,4.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,8.27,8.27,8.27,98,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,114.46,59,343.38,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,52.8,30.49,158.4,64,percent of total billed charges,,,33.6,,19.58,19.49,33.6,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,53.09,19.49,195.55,67,percent of total billed charges,,,34.6,,190.57,73.91,336.04,67,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,9.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,19.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,9.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,29,29,50,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,8.27,8.27,8.27,371,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,9.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,9.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.09,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,9.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,9.3,448,,facility
ANTIPSYCHOTICS NOS 1-3,80342,CPT,301,RC,,,,outpatient,,,270,27,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
ASSAY OF URINE CREATININE,82570,CPT,301,RC,,,,outpatient,,,46,4.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.61,4.61,4.61,213,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,71.39,41.89,142.78,14,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,37.49,23.86,74.98,60,percent of total billed charges,,,33.6,,37.49,23.85,81.31,18,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,24.07,23.86,47.71,75,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,10.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,60.5,4.61,151,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,14.91,14.91,25.41,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,85.58,85.58,85.58,1 through 10,percent of total billed charges,,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.61,4.61,4.61,636,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.18,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.18,448,,facility
RICKETTSIA ANTIBODY,86757,CPT,302,RC,,,,outpatient,,,48,4.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,17.21,17.21,17.21,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,40.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,20.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,17.21,17.21,17.21,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,20.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,41.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,19.35,448,,facility
TREPONEMA PALLIDUM,86780,CPT,302,RC,,,,outpatient,,,9.08,0.91,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.78,11.78,11.78,612,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,10.62,10.62,50.15,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,9.5,6.05,48.53,46,percent of total billed charges,,,33.6,,6.05,6.05,44.88,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,6.05,6.05,28.56,66,percent of total billed charges,,,34.6,,73.69,20.19,77.34,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,9,9,42.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,17.85,17.85,17.85,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,11.78,11.78,11.78,1 through 10,percent of total billed charges,,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.78,11.78,11.78,550,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.6,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.24,448,,facility
CMV ANTIBODY IGM,86645,CPT,302,RC,,,,outpatient,,,30.6,3.06,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,14.99,14.99,14.99,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,27.52,27.52,27.52,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,163.38,163.38,163.38,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,19.83,19.82,19.83,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,35.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,14.99,0.22,14.99,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.4,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,16.85,448,,facility
ASSAY OF ETHYLENE GLYCOL,82693,CPT,301,RC,,,,outpatient,,,25,2.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,31.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.25,13.25,13.25,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.2,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,15.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.9,448,,facility
ASSAY OF FREE THYROXINE,84439,CPT,301,RC,,,,outpatient,,,51.24,5.12,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,8.02,8.02,8.02,335,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,53.1,53.1,309.16,13,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,47.52,30.24,276.67,112,percent of total billed charges,,,33.6,,47.52,30.24,276.67,25,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,30.24,30.24,176.06,119,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,9.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,18.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,9.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,45.13,45,262,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,18.9,18.9,18.9,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,8.02,8.02,8.02,954,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,9.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,9.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.48,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,9.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,9.02,448,,facility
ASSAY OF ERYTHROPOIETIN,82668,CPT,301,RC,,,,outpatient,,,38.5,3.85,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.71,16.71,16.71,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,21.65,21.65,48.05,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,76.94,76.94,76.94,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,39.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.71,16.71,16.71,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,40.6,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.79,448,,facility
PMS2 GENE DUP/DELET VARIANTS,81319,CPT,310,RC,,,,outpatient,,,73,7.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,203.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,203.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,209.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,203.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,425.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,215.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,203.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,215.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,356.13,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,207.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,203.5,448,,facility
T CELLS TOTAL COUNT,86359,CPT,302,RC,,,,outpatient,,,39.5,3.95,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,33.56,33.56,33.56,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,37.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,37.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,82.68,82.68,82.68,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,78.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,39.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,33.56,33.56,33.56,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,39.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,81.52,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,38.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,37.73,448,,facility
TP53 GENE FULL GENE SEQUENCE,81351,CPT,310,RC,,,,outpatient,,,400,40,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,641.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,641.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,661.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,641.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1341.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,680.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,641.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,680.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1123.24,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,654.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1341.47,,facility
MOPATH PROCEDURE LEVEL 5,81404,CPT,310,RC,,,,outpatient,,,335,33.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,274.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,274.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,283.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,274.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,574.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,291.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,274.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,291.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,480.95,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,280.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,274.83,574.39,,facility
ASSAY OF FREE TESTOSTERONE,84402,CPT,301,RC,,,,outpatient,,,55,5.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,22.66,22.66,22.66,39,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,54.28,54.28,54.28,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,48.58,20.59,48.58,16,percent of total billed charges,,,33.6,,123.65,123.65,123.65,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,30.91,13.1,31.19,15,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,25.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,53.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,19.32,19.32,19.32,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,22.66,22.66,22.66,50,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,25.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,55.04,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,25.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,25.47,448,,facility
DRUG SCREENING METHADONE,80358,CPT,301,RC,,,,outpatient,,,370,37,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
DRUG SCREEN AMPHETAMINES 1/2,80324,CPT,301,RC,,,,outpatient,,,119,11.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
ASSAY OF LIPOPROTEIN(A),83695,CPT,301,RC,,,,outpatient,,,37.6,3.76,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.74,12.74,12.74,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,21.65,13.78,33.26,13,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,21.17,21.17,21.19,14,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,29.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,31.5,31.5,31.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.74,12.74,12.74,13,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.97,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.32,448,,facility
VIRUS ANTIBODY NOS,86790,CPT,302,RC,,,,outpatient,,,44,4.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.46,11.46,11.46,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,107.86,20.06,169.49,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,116.52,40.29,122.3,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,26.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.46,11.46,11.46,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.88,448,,facility
ASSAY OF RENIN,84244,CPT,301,RC,,,,outpatient,,,41,4.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.56,19.56,19.56,13,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,24.19,24.19,63.13,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,21.65,13.78,21.65,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,13.78,13.78,35.95,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,21.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,45.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,23.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.56,19.56,19.56,29,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,21.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,23.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,47.51,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,22.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,21.99,448,,facility
REPTILASE TEST,85635,CPT,305,RC,,,,outpatient,,,87.4,8.74,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,9.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,20.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,9.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.28,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,10.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,9.85,448,,facility
IMMUNOASSAY QUANT NOS NONAB,83520,CPT,301,RC,,,,outpatient,,,32,3.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,36,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,66.08,66.08,66.08,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,41.18,24.82,318.38,1 through 10,percent of total billed charges,,,33.6,,37.63,37.63,96.43,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,33.6,23.18,176.4,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,36.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,87,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.22,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.27,448,,facility
GALECTIN-3,82777,CPT,301,RC,,,,outpatient,,,225,22.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,44.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,44.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,45.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,44.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,92.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,46.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,44.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,46.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,77.44,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,45.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,44.25,448,,facility
CHEMILUMINESCENT ASSAY,82397,CPT,301,RC,,,,outpatient,,,43,4.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.56,12.56,12.56,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,22.85,22.85,22.85,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,29.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.56,12.56,12.56,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.5,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.12,448,,facility
ASSAY OF ETHYLENE GLYCOL,82693,CPT,301,RC,,,,outpatient,,,238,23.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,31.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.25,13.25,13.25,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.2,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,15.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.9,448,,facility
ASSAY FOR CALPROTECTIN FECAL,83993,CPT,301,RC,,,,outpatient,,,244,24.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,17.46,17.46,17.46,30,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,158.4,100.8,168.43,1 through 10,percent of total billed charges,,,33.6,,168.43,100.8,225.98,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,107.18,107.18,107.18,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,41.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,20.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,159.5,159.5,159.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,17.46,17.46,17.46,68,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,20.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.42,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,20.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,19.63,448,,facility
DRUG TEST PRSMV CHEM ANLYZR,80307,CPT,301,RC,,,,outpatient,,,55,5.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,55.27,55.27,55.27,34,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,62.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,62.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,171.87,131.38,223.26,14,percent of total billed charges,,,33.6,,206.45,131.38,223.26,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,131.38,102.04,131.38,13,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,62.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,129.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,65.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,55.27,55.27,55.27,332,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,62.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,65.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,125.7,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,63.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,62.14,448,,facility
FLUORESCENT ANTIBODY SCREEN,86255,CPT,302,RC,,,,outpatient,,,15,1.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.72,10.72,10.72,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,45.41,28.9,1068.67,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,28.9,28.9,28.9,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.72,10.72,10.72,19,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.04,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.05,448,,facility
ASSAY OF PSA COMPLEXED,84152,CPT,301,RC,,,,outpatient,,,42.5,4.25,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,39.74,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.39,448,,facility
COMPATIBILITY TEST SPIN,86920,CPT,302,RC,,,,outpatient,,,10,1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,150.35,150.35,150.35,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,167.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,317.86,317.86,635.71,1 through 10,percent of total billed charges,,,33.6,,343.74,343.74,343.74,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,229.36,218.53,229.36,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,340.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,172.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,1264.2,1264.2,1264.2,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,14.05,14.05,14.05,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,172.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,226.07,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,166.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,163.06,448,,facility
RHEUMATOID FACTOR QUANT,86431,CPT,302,RC,,,,outpatient,,,6,0.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.04,5.04,5.04,26,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,33.63,33.63,33.63,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,30.1,19.05,30.1,1 through 10,percent of total billed charges,,,33.6,,19.15,19.15,30.1,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,19.15,19.15,19.24,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,11.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.04,5.04,5.04,75,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.25,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.67,448,,facility
GABAPENTIN NON-BLOOD,80355,CPT,301,RC,,,,outpatient,,,35,3.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
DRUG ASSAY ADALIMUMAB,80145,CPT,301,RC,,,,outpatient,,,249,24.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,39.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,38.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,80.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,40.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,34.31,34.31,34.31,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,38.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,40.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,67.5,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,39.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,38.57,448,,facility
BENZODIAZEPINES1-12,80346,CPT,301,RC,,,,outpatient,,,184,18.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
STOOL CULTR AEROBIC BACT EA,87046,CPT,306,RC,,,,outpatient,,,33,3.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,62.83,62.83,62.83,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,9.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,19.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,9.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.41,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,9.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,9.44,448,,facility
BL SMEAR W/DIFF WBC COUNT,85007,CPT,305,RC,,,,outpatient,,,5,0.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.38,3.38,3.38,135,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,407.04,8.32,467.84,76,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,7.67,7.67,431.29,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,385.97,6.86,417.4,56,percent of total billed charges,,,33.6,,245.62,245.62,245.62,33,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,242.32,4.37,245.62,60,percent of total billed charges,,,34.6,,265.35,265.35,265.35,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,7.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,6.5,3.38,365.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,153.51,153.51,153.51,1 through 10,percent of total billed charges,,,35,,318,318,318,1 through 10,percent of total billed charges,,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.38,3.38,3.38,861,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.42,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,3.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,3.8,448,,facility
QUANTITATIVE ASSAY DRUG,80299,CPT,301,RC,,,,outpatient,,,93,9.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,13,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,174.64,174.64,174.64,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,171.6,171.6,171.6,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,374.52,374.52,374.52,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.62,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.64,448,,facility
F5 GENE,81241,CPT,310,RC,,,,outpatient,,,438,43.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,65.26,65.26,65.26,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,73.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,73.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,219.41,219.41,219.41,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,73.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,153.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,77.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,65.26,65.26,65.26,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,73.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,77.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,132.02,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,74.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,73.37,448,,facility
ASSAY OF URINE CREATININE,82570,CPT,301,RC,,,,outpatient,,,61,6.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.61,4.61,4.61,213,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,71.39,41.89,142.78,14,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,37.49,23.86,74.98,60,percent of total billed charges,,,33.6,,37.49,23.85,81.31,18,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,24.07,23.86,47.71,75,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,10.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,60.5,4.61,151,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,14.91,14.91,25.41,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,85.58,85.58,85.58,1 through 10,percent of total billed charges,,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.61,4.61,4.61,636,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.18,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.18,448,,facility
ASSAY OF COPPER,82525,CPT,301,RC,,,,outpatient,,,230,23,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.04,11.04,11.04,18,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,35.64,22.85,35.9,1 through 10,percent of total billed charges,,,33.6,,80.64,80.64,80.64,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,22.85,19.49,22.85,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,50.4,50.4,50.4,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.04,11.04,11.04,37,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.81,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.41,448,,facility
QUANTITATIVE ASSAY DRUG,80299,CPT,301,RC,,,,outpatient,,,135,13.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,13,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,174.64,174.64,174.64,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,171.6,171.6,171.6,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,374.52,374.52,374.52,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.62,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.64,448,,facility
ASSAY OF CALCITONIN,82308,CPT,301,RC,,,,outpatient,,,45.1,4.51,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,23.83,23.83,23.83,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,26.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,55.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,28.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,23.83,23.83,23.83,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,26.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,28.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,57.89,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,27.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,26.79,448,,facility
FLOWCYTOMETRY/TC ADD-ON,88185,CPT,311,RC,,,,outpatient,,,47,4.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,456.96,430.08,1705.1,168,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,52.8,,399.84,399.84,2815.68,17,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,1759.8,1759.8,1759.8,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.72,18.35,330.3,23,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,53.55,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",53.55,448,,facility
HLA II TYPING 1 LOCUS LR,81376,CPT,310,RC,,,,outpatient,,,85,8.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,122.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,122.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,125.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,122.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,255.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,129.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,122.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,129.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,264.06,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,124.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,122.22,448,,facility
HERPES SIMPLEX TYPE 1 TEST,86695,CPT,302,RC,,,,outpatient,,,34,3.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.73,11.73,11.73,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,20.59,20.59,42.71,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,13.1,13.1,13.1,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.73,11.73,11.73,15,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.49,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.19,448,,facility
ASSAY OF SIROLIMUS,80195,CPT,301,RC,,,,outpatient,,,58.5,5.85,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,36.62,36.62,108.14,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,28.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,54.5,54.5,54.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.21,12.21,12.21,66,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.68,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.73,448,,facility
BENZODIAZEPINES 13 OR MORE,80347,CPT,301,RC,,,,outpatient,,,63,6.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
INSULIN ANTIBODIES,86337,CPT,302,RC,,,,outpatient,,,55.5,5.55,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.04,19.04,19.04,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,34.85,34.85,34.85,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,21.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,44.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.04,19.04,19.04,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,21.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,46.25,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,21.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,21.41,448,,facility
EHRLICHIA ANTIBODY,86666,CPT,302,RC,,,,outpatient,,,131,13.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,7.53,7.53,7.53,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,21.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9.05,9.05,9.05,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.98,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,10.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,10.18,448,,facility
DRUG SCREENING COCAINE,80353,CPT,301,RC,,,,outpatient,,,195,19.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
LACTOFERRIN FECAL (QUAL),83630,CPT,301,RC,,,,outpatient,,,31.7,3.17,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,17.52,17.52,17.52,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,25.2,25.2,25.2,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,41.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,20.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,17.52,17.52,17.52,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,20.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.42,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,20.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,19.7,448,,facility
VIRUS INOCULATE TISSUE ADDL,87253,CPT,306,RC,,,,outpatient,,,182.5,18.25,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,20.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,42.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,21.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,20.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,21.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,43.65,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,20.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,20.2,448,,facility
ASSAY PH BODY FLUID NOS,83986,CPT,301,RC,,,,outpatient,,,9,0.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.18,3.18,3.18,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,75.43,75.43,75.43,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,7.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.18,3.18,3.18,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.74,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,3.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,3.58,448,,facility
DIPROPYLACETIC ACID FREE,80165,CPT,301,RC,,,,outpatient,,,46.35,4.64,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,28.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.26,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.54,448,,facility
ASSAY OF PHENOBARBITAL,80184,CPT,301,RC,,,,outpatient,,,25,2.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,31.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.61,13.61,13.61,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.78,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,15.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,15.3,448,,facility
MURAMIDASE,85549,CPT,305,RC,,,,outpatient,,,41.6,4.16,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.68,16.68,16.68,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,35.38,35.38,35.38,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,39.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.68,16.68,16.68,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,40.51,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.75,448,,facility
ASSAY PHOSPHOHEXOSE ENZYMES,84087,CPT,301,RC,,,,outpatient,,,100,10,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,22.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.3,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,10.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,10.73,448,,facility
PHENOTYPE INFECT AGENT DRUG,87900,CPT,306,RC,,,,outpatient,,,205,20.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,130.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,130.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,134.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,130.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,272.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,138.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,130.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,138.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,281.61,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,132.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,130.35,448,,facility
ASSAY OF GENTAMICIN,80170,CPT,301,RC,,,,outpatient,,,15,1.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,34.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.39,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,16.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,16.38,448,,facility
QUANTITATIVE ASSAY DRUG,80299,CPT,301,RC,,,,outpatient,,,59,5.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,13,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,174.64,174.64,174.64,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,171.6,171.6,171.6,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,374.52,374.52,374.52,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.62,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.64,448,,facility
HEXAGNAL PHOSPH PLTLT NEUTRL,85598,CPT,305,RC,,,,outpatient,,,169,16.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.99,15.99,15.99,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,168.32,168.32,168.32,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,37.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.98,448,,facility
DEHYDROEPIANDROSTERONE,82626,CPT,301,RC,,,,outpatient,,,62,6.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,22.48,22.48,22.48,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,29.9,29.9,29.9,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,25.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,52.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,26.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,22.48,22.48,22.48,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,25.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,26.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,54.6,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,25.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,25.27,448,,facility
HEPARIN ASSAY,85520,CPT,305,RC,,,,outpatient,,,75,7.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.64,11.64,11.64,13,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,131.71,49.68,223.83,17,percent of total billed charges,,,33.6,,131.71,131.71,131.71,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,131.76,131.71,132.89,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,196,196,196,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,82.32,82.32,82.32,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.64,11.64,11.64,91,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.28,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.09,448,,facility
HERPES SIMPLEX TYPE 2 TEST,86696,CPT,302,RC,,,,outpatient,,,110.5,11.05,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,17.21,17.21,17.21,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,20.59,20.59,42.71,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,13.1,13.1,13.1,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,40.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,20.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,17.21,17.21,17.21,12,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,20.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,41.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,19.35,448,,facility
ASSAY ALKALINE PHOSPHATASE,84075,CPT,301,RC,,,,outpatient,,,4,0.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.61,4.61,4.61,50,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,15.34,10.36,15.34,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,81,81,81,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,46.25,13.73,46.25,76,percent of total billed charges,,,33.6,,27.22,8.74,46.25,18,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,27.22,8.74,27.46,55,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,10.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,40.5,13,40.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,5.46,5.46,5.46,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.61,4.61,4.61,627,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.18,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.18,448,,facility
ASSAY OF CREATININE,82565,CPT,301,RC,,,,outpatient,,,4,0.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.55,4.55,4.55,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,34.22,10.24,34.22,11,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,30.62,19.49,61.25,61,percent of total billed charges,,,33.6,,19.49,19.49,38.98,20,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,19.49,19.49,38.98,55,percent of total billed charges,,,34.6,,30.62,30.62,30.62,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,10.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,29,29,29,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,12.18,12.18,12.18,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.55,4.55,4.55,281,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.08,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.12,448,,facility
ASSAY OF URINE PHOSPHORUS,84105,CPT,301,RC,,,,outpatient,,,7,0.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.14,5.14,5.14,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,12.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.18,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.78,448,,facility
DRUG ASSAY CAFFEINE,80155,CPT,301,RC,,,,outpatient,,,37.4,3.74,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,39.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,38.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,80.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,40.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,38.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,40.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,67.5,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,39.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,38.57,448,,facility
ASSAY OF FREE TESTOSTERONE,84402,CPT,301,RC,,,,outpatient,,,57,5.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,22.66,22.66,22.66,39,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,54.28,54.28,54.28,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,48.58,20.59,48.58,16,percent of total billed charges,,,33.6,,123.65,123.65,123.65,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,30.91,13.1,31.19,15,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,25.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,53.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,19.32,19.32,19.32,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,22.66,22.66,22.66,50,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,25.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,55.04,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,25.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,25.47,448,,facility
COMPLEMENT ANTIGEN,86160,CPT,302,RC,,,,outpatient,,,44,4.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.67,10.67,10.67,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,87.32,87.32,87.32,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,78.14,49.73,270.86,17,percent of total billed charges,,,33.6,,49.73,49.73,172.37,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,49.73,29.23,50.32,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,256.5,256.5,256.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.67,10.67,10.67,61,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.92,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12,448,,facility
DETECT AGENT NOS DNA QUANT,87799,CPT,306,RC,,,,outpatient,,,265,26.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,38.11,38.11,38.11,39,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,44.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,200.64,91.44,597.79,1 through 10,percent of total billed charges,,,33.6,,203.95,203.95,203.95,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,231.27,203.95,231.27,11,percent of total billed charges,,,34.6,,220.34,220.34,231.27,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,89.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,45.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,38.11,38.11,38.11,221,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,45.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,92.54,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,43.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,42.84,448,,facility
ASSAY OF CADMIUM,82300,CPT,301,RC,,,,outpatient,,,63,6.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,23.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,23.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,23.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,49.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,25.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,21.03,21.03,21.03,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,23.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,25.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,50.02,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,24.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,23.64,448,,facility
ASY HYDROXYPROGESTERONE 17-D,83498,CPT,301,RC,,,,outpatient,,,40,4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,24.17,24.17,24.17,28,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,27.14,27.14,27.14,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,37.17,36.96,302.02,1 through 10,percent of total billed charges,,,33.6,,23.52,23.52,23.52,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,23.52,15.46,96.1,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,27.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,56.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,28.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,24.17,24.17,24.17,45,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,27.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,28.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,58.7,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,27.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,27.17,448,,facility
ASSAY OF VITAMIN K,84597,CPT,301,RC,,,,outpatient,,,142.5,14.25,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.2,12.2,12.2,11,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,105.6,105.6,105.6,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,28.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.2,2.11,12.2,20,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.65,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.72,448,,facility
HSV DNA QUANT,87530,CPT,306,RC,,,,outpatient,,,137.5,13.75,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,44.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,89.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,45.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,45.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,92.54,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,43.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,42.84,448,,facility
MASS SPECTROMETRY QUAL/QUAN,83789,CPT,301,RC,,,,outpatient,,,285,28.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,24.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,50.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,25.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,24.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,25.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.19,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,24.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,24.11,448,,facility
THROMBOXANE URINE,84431,CPT,301,RC,,,,outpatient,,,181,18.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,61.44,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.11,448,,facility
ASSAY OF HISTAMINE,83088,CPT,301,RC,,,,outpatient,,,39.55,3.96,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,29.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,61.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,31.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,26.27,26.27,26.27,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,29.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,31.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,63.81,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,30.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,29.53,448,,facility
ASSAY BLOOD CARBON DIOXIDE,82374,CPT,301,RC,,,,outpatient,,,72.5,7.25,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.34,4.34,4.34,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,9.76,9.76,9.76,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,48.54,28.56,48.54,1 through 10,percent of total billed charges,,,33.6,,28.56,28.56,28.56,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,28.57,28.56,57.12,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,10.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.34,4.34,4.34,35,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.55,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,4.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,4.88,448,,facility
HEPATITIS DELTA AGENT ANTBDY,86692,CPT,302,RC,,,,outpatient,,,1450,145,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,35.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,37.08,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.16,448,,facility
ASSAY CARBAMAZEPINE TOTAL,80156,CPT,301,RC,,,,outpatient,,,18,1.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,47.04,47.04,47.04,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,30.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.96,12.96,12.96,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,31.47,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.57,448,,facility
BENZODIAZEPINES1-12,80346,CPT,301,RC,,,,outpatient,,,130,13,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
GENOME SEQUENCE ANALYSIS,81426,CPT,310,RC,,,,outpatient,,,2541,254.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2709.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2709.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2791.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2709.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,5663.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2872.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2709.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2872.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4742.41,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,2764.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,5663.8,,facility
DRUG SCREENING PREGABALIN,80366,CPT,301,RC,,,,outpatient,,,40,4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
ASSAY OF ALDOSTERONE,82088,CPT,301,RC,,,,outpatient,,,55,5.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,36.25,36.25,36.25,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,32.45,32.45,63.72,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,40.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,40.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,41.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,29.04,18.48,29.04,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,18.48,17.81,46.37,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,40.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,85.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,43.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,36.25,36.25,36.25,24,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,40.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,43.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,88.04,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,41.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,40.75,448,,facility
SYPHILIS TEST NON-TREP QUAL,86592,CPT,302,RC,,,,outpatient,,,20,2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.8,3.8,3.8,262,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,28.8,3.16,28.8,20,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,26.55,26.4,79.65,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,28.8,28.8,28.8,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,23.76,15.12,23.76,39,percent of total billed charges,,,33.6,,15.17,15.12,45.36,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,15.12,15.12,15.17,34,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,8.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,22.38,22.38,22.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.8,3.8,3.8,282,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.22,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,4.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,4.27,448,,facility
COMPLEMENT ANTIGEN,86160,CPT,302,RC,,,,outpatient,,,110,11,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.67,10.67,10.67,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,87.32,87.32,87.32,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,78.14,49.73,270.86,17,percent of total billed charges,,,33.6,,49.73,49.73,172.37,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,49.73,29.23,50.32,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,256.5,256.5,256.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.67,10.67,10.67,61,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.92,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12,448,,facility
RUBELLA ANTIBODY,86762,CPT,302,RC,,,,outpatient,,,35,3.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.8,12.8,12.8,18,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,28.32,28.32,28.32,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,25.34,16.13,25.34,14,percent of total billed charges,,,33.6,,16.13,16.13,16.13,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,16.13,16.13,16.27,22,percent of total billed charges,,,34.6,,68.61,68.61,68.61,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,30.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,24,24,44.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,12.8,12.8,12.8,1 through 10,percent of total billed charges,,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.8,12.8,12.8,185,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,31.1,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.39,448,,facility
QUANTITATIVE ASSAY DRUG,80299,CPT,301,RC,,,,outpatient,,,115.8,11.58,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,13,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,174.64,174.64,174.64,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,171.6,171.6,171.6,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,374.52,374.52,374.52,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.62,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.64,448,,facility
ENTEROVIRUS PROBE&REVRS TRNS,87498,CPT,306,RC,,,,outpatient,,,100.75,10.08,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
RBC SICKLE CELL TEST,85660,CPT,305,RC,,,,outpatient,,,9,0.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.9,4.9,4.9,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,89.04,89.04,139.92,1 through 10,percent of total billed charges,,,33.6,,139.92,139.92,139.92,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,96.19,18.19,100.96,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,11.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,81.27,81.27,105.04,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.9,4.9,4.9,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.9,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.51,448,,facility
DRUG SCREENING OXYCODONE,80365,CPT,301,RC,,,,outpatient,,,40,4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
COCCIDIOIDES ANTIBODY,86635,CPT,302,RC,,,,outpatient,,,57,5.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,107.18,107.18,107.18,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,23.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.2,10.2,10.2,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.8,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,11.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.47,448,,facility
ASSAY OF VITAMIN A,84590,CPT,301,RC,,,,outpatient,,,41.4,4.14,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.33,10.33,10.33,22,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,34.32,34.32,34.32,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,21.84,16.13,21.84,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,24.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,32.5,32.5,32.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.33,10.33,10.33,58,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.08,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,11.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.61,448,,facility
NK CELLS TOTAL COUNT,86357,CPT,302,RC,,,,outpatient,,,173,17.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,33.56,33.56,33.56,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,60.77,60.77,60.77,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,37.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,37.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,27.98,27.98,27.98,1 through 10,percent of total billed charges,,,33.6,,33.56,33.56,33.56,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,537.59,537.59,537.59,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,78.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,39.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,33.56,33.56,33.56,25,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,39.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,81.52,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,38.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,37.73,448,,facility
CREATININE CLEARANCE TEST,82575,CPT,301,RC,,,,outpatient,,,20.5,2.05,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,205.82,37.91,216.03,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,9.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,19.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,8.41,8.41,8.41,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,9.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.42,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,9.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,9.46,448,,facility
MOPATH PROCEDURE LEVEL 6,81405,CPT,310,RC,,,,outpatient,,,625,62.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,301.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,301.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,310.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,301.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,629.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,319.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,301.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,319.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,527.36,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,307.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,301.35,629.82,,facility
ASSAY OF CALCIUM IN URINE,82340,CPT,301,RC,,,,outpatient,,,25,2.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.36,5.36,5.36,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,19.15,19.15,123.98,1 through 10,percent of total billed charges,,,33.6,,123.98,123.98,123.98,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,19.15,19.15,19.15,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,12.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.36,5.36,5.36,54,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.02,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,6.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,6.03,448,,facility
NUCLEAR ANTIGEN ANTIBODY,86235,CPT,302,RC,,,,outpatient,,,24,2.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13,12.5,15.95,11,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,54.91,4.37,90.29,43,percent of total billed charges,,,33.6,,4.37,4.37,53.09,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,22.18,4.24,83.33,13,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,37.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.95,13,15.95,54,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.75,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.93,448,,facility
ASSAY OF PHENYTOIN FREE,80186,CPT,301,RC,,,,outpatient,,,37,3.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,73.92,73.92,73.92,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,28.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.24,12.24,12.24,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.73,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.76,448,,facility
QUANTITATIVE ASSAY DRUG,80299,CPT,301,RC,,,,outpatient,,,193,19.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,13,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,174.64,174.64,174.64,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,171.6,171.6,171.6,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,374.52,374.52,374.52,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.62,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.64,448,,facility
ASSAY OF THYROID ACTIVITY,84442,CPT,301,RC,,,,outpatient,,,55.94,5.59,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.15,13.15,13.15,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,30.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,31,31,31,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.15,13.15,13.15,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,31.94,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,15.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.78,448,,facility
ASSAY PHOSPHOHEXOSE ENZYMES,84087,CPT,301,RC,,,,outpatient,,,67,6.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,22.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.3,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,10.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,10.73,448,,facility
SKEL MUSC RELAXANT 3 OR MORE,80370,CPT,301,RC,,,,outpatient,,,40,4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
VARICELLA-ZOSTER ANTIBODY,86787,CPT,302,RC,,,,outpatient,,,105,10.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.46,11.46,11.46,39,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,82.6,23.01,82.6,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,47.54,20.59,129.19,22,percent of total billed charges,,,33.6,,47.04,47.04,266.64,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,47.04,47.04,47.54,21,percent of total billed charges,,,34.6,,221.19,221.19,221.19,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,26.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,70,70,252.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,24.36,24.36,24.36,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,11.46,11.46,11.46,1 through 10,percent of total billed charges,,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.46,11.46,11.46,200,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.88,448,,facility
T3 REVERSE,84482,CPT,301,RC,,,,outpatient,,,32,3.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,14.02,14.02,14.02,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,32.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,34.06,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,16.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,15.76,448,,facility
ASSAY OF PORPHOBILINOGEN,84110,CPT,301,RC,,,,outpatient,,,32.4,3.24,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,30.1,30.1,30.1,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,17.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.24,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,8.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,8.44,448,,facility
HLA II TYPE 1 AG EQUIV LR,81377,CPT,310,RC,,,,outpatient,,,381,38.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,94.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,94.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,97.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,94.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,198.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,94.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,198.36,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,96.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,94.74,448,,facility
LACTATE (LD) (LDH) ENZYME,83615,CPT,301,RC,,,,outpatient,,,8,0.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.37,5.37,5.37,60,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,38.94,38.94,38.94,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,34.85,11.09,34.85,38,percent of total billed charges,,,33.6,,22.18,22.18,22.18,46,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,20.95,20.95,22.18,22,percent of total billed charges,,,34.6,,23.96,20.95,25.15,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,12.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,13.86,13.86,13.86,17,percent of total billed charges,,,35,,27.5,27.5,27.5,1 through 10,percent of total billed charges,,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.37,5.37,5.37,235,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.04,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,6.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,6.04,448,,facility
MICROSOMAL ANTIBODY EACH,86376,CPT,302,RC,,,,outpatient,,,34,3.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.94,12.94,12.94,22,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,22.18,14.11,82.9,1 through 10,percent of total billed charges,,,33.6,,22.51,22.51,22.51,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,22.51,11.27,81.98,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,30.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.94,12.94,12.94,63,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,31.43,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.55,448,,facility
ASSAY OF GGT,82977,CPT,301,RC,,,,outpatient,,,4,0.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,6.4,6.4,6.4,117,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,231.28,231.28,231.28,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,223.83,36.43,223.83,54,percent of total billed charges,,,33.6,,131.71,23.18,206.98,13,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,23.39,23.18,132.89,33,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,6.4,6.4,6.4,1 through 10,percent of total billed charges,,7.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,15.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,7.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,196,34.5,196,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,6.4,6.4,6.4,714,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,7.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,7.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.56,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,7.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,7.2,448,,facility
PROTOZOA ANTIBODY NOS,86753,CPT,302,RC,,,,outpatient,,,153,15.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.02,11.02,11.02,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,98.11,98.11,154.18,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,96.77,32.38,106,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.02,11.02,11.02,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.76,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.39,448,,facility
QUANTITATIVE ASSAY DRUG,80299,CPT,301,RC,,,,outpatient,,,48,4.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,13,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,174.64,174.64,174.64,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,171.6,171.6,171.6,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,374.52,374.52,374.52,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.62,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.64,448,,facility
ENZYME CELL ACTIVITY,82657,CPT,301,RC,,,,outpatient,,,317.6,31.76,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.72,19.72,19.72,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,2094.14,2094.14,2094.14,1 through 10,percent of total billed charges,,,33.6,,762.96,762.96,762.96,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,46.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,23.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.72,19.72,19.72,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,23.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,39.01,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,22.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,22.17,448,,facility
IMMUNE COMPLEX ASSAY,86332,CPT,302,RC,,,,outpatient,,,60,6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,24.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,50.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,25.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,24.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,25.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,52.66,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,24.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,24.37,448,,facility
TREPONEMA PALLIDUM,86780,CPT,302,RC,,,,outpatient,,,33,3.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.78,11.78,11.78,612,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,10.62,10.62,50.15,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,9.5,6.05,48.53,46,percent of total billed charges,,,33.6,,6.05,6.05,44.88,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,6.05,6.05,28.56,66,percent of total billed charges,,,34.6,,73.69,20.19,77.34,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,9,9,42.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,17.85,17.85,17.85,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,11.78,11.78,11.78,1 through 10,percent of total billed charges,,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.78,11.78,11.78,550,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.6,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.24,448,,facility
RBC PRETX INCUBATJ W/ENZYMES,86971,CPT,302,RC,,,,outpatient,,,127.5,12.75,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,167.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,1346.4,728.02,1346.4,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,925.65,925.65,925.65,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,340.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,172.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,172.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,377,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,166.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,163.06,448,,facility
UR ALBUMIN QUANTITATIVE,82043,CPT,301,RC,,,,outpatient,,,37.26,3.73,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.14,5.14,5.14,85,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,38.35,29.5,51.92,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,46.46,26.4,46.46,31,percent of total billed charges,,,33.6,,29.57,16.95,46.6,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,29.57,21.84,29.92,43,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,12.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,163.5,32.5,188.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,13.65,13.65,18.53,1 through 10,percent of total billed charges,,,35,,17.34,17.34,17.34,1 through 10,percent of total billed charges,,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.14,5.14,5.14,290,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.5,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.78,448,,facility
MUCOPOLYSACCHARIDES,83864,CPT,301,RC,,,,outpatient,,,265,26.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,25.35,25.35,25.35,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,54.38,54.38,54.38,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,28.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,59.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,30.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,28.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,30.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,49.88,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,29.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,28.5,448,,facility
SPECTROPHOTOMETRY,84311,CPT,301,RC,,,,outpatient,,,112.5,11.25,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,7.2,7.2,7.2,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,45.35,45.35,53.33,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,16.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,7.2,7.2,7.2,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.1,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,8.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,8.1,448,,facility
NUCLEAR ANTIGEN ANTIBODY,86235,CPT,302,RC,,,,outpatient,,,42.5,4.25,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13,12.5,15.95,11,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,54.91,4.37,90.29,43,percent of total billed charges,,,33.6,,4.37,4.37,53.09,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,22.18,4.24,83.33,13,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,37.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.95,13,15.95,54,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.75,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.93,448,,facility
SKEL MUSC RELAXANT 3 OR MORE,80370,CPT,301,RC,,,,outpatient,,,35,3.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
RUBEOLA ANTIBODY,86765,CPT,302,RC,,,,outpatient,,,34,3.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.46,11.46,11.46,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,22.18,22.18,83.95,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,20.68,20.68,20.68,1 through 10,percent of total billed charges,,,34.6,,61.35,61.35,61.35,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,26.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,44,44,44,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.46,11.46,11.46,18,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.88,448,,facility
RIA NONANTIBODY,83519,CPT,301,RC,,,,outpatient,,,53.15,5.32,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,55.44,55.44,55.44,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.37,16.37,16.37,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.2,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.4,448,,facility
IMMUNOASSAY NONANTIBODY,83516,CPT,301,RC,,,,outpatient,,,43,4.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9,9,10.26,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,4.75,4.75,218.59,30,percent of total billed charges,,,33.6,,3.02,3.02,175.39,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,3.02,3.02,211.68,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,24.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,23.5,23.5,23.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9,9,10.26,51,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.92,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,11.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.53,448,,facility
COMPLEMENT/FUNCTION ACTIVITY,86161,CPT,302,RC,,,,outpatient,,,82.5,8.25,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.92,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12,448,,facility
ASY HYDROXYPROGESTERONE 17-D,83498,CPT,301,RC,,,,outpatient,,,53,5.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,24.17,24.17,24.17,28,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,27.14,27.14,27.14,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,37.17,36.96,302.02,1 through 10,percent of total billed charges,,,33.6,,23.52,23.52,23.52,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,23.52,15.46,96.1,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,27.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,56.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,28.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,24.17,24.17,24.17,45,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,27.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,28.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,58.7,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,27.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,27.17,448,,facility
AMPHETAMINES 5 OR MORE,80326,CPT,301,RC,,,,outpatient,,,268,26.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
LIPID PANEL,80061,CPT,301,RC,,,,outpatient,,,8,0.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.91,11.91,11.91,1021,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,34.81,34.81,34.81,26,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,37.76,37.76,37.76,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,31.15,19.82,31.15,172,percent of total billed charges,,,33.6,,20,19.82,31.15,37,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,19.82,19.82,20,389,percent of total billed charges,,,34.6,,21.83,21.83,21.83,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,29.5,29.5,123.5,11,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,12.39,12.39,51.87,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.91,11.91,11.91,1133,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.93,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.39,448,,facility
THYROGLOBULIN ANTIBODY,86800,CPT,302,RC,,,,outpatient,,,152,15.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,14.15,14.15,14.15,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,19.47,19.47,92.63,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,17.42,11.09,82.9,1 through 10,percent of total billed charges,,,33.6,,41.02,41.02,52.75,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,41.02,11.09,52.75,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,33.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,14.15,14.15,14.15,30,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,34.37,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,16.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,15.91,448,,facility
FIBRINOLYSINS SCREEN I&R,85390,CPT,305,RC,,,,outpatient,,,64,6.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.77,13.77,13.77,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,24.82,24.82,24.82,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,9.07,9.07,9.07,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,32.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.77,13.77,13.77,12,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.09,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,15.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,15.48,448,,facility
HEROIN METABOLITE,80356,CPT,301,RC,,,,outpatient,,,119,11.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
VIRUS ANTIBODY NOS,86790,CPT,302,RC,,,,outpatient,,,138,13.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.46,11.46,11.46,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,107.86,20.06,169.49,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,116.52,40.29,122.3,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,26.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.46,11.46,11.46,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.88,448,,facility
SPECTROPHOTOMETRY,84311,CPT,301,RC,,,,outpatient,,,8,0.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,7.2,7.2,7.2,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,45.35,45.35,53.33,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,16.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,7.2,7.2,7.2,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.1,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,8.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,8.1,448,,facility
GENE ANALYSIS (CYTOCHROME P450; FAMILY 2; SUBFAMILY C; POLYPEPTIDE 19) COMMON VARIANTS,81225,CPT,0310,RC,,,,outpatient,,,278.65,27.87,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,291.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,291.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,300.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,291.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,608.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,308.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,291.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,308.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,509.88,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,297.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,291.36,608.94,,facility
RENAL FUNCTION PANEL,80069,CPT,301,RC,,,,outpatient,,,5,0.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,7.72,7.72,7.72,44,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,32.45,7.72,32.45,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,29.04,18.48,254.93,17,percent of total billed charges,,,33.6,,18.48,18.48,18.48,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,18.48,18.48,252.67,27,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,18.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,9.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,27.5,27.5,27.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,7.72,7.72,7.72,276,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,9.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.76,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,8.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,8.68,448,,facility
PHENOTYPE INFECT AGENT DRUG,87900,CPT,306,RC,,,,outpatient,,,210,21,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,130.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,130.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,134.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,130.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,272.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,138.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,130.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,138.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,281.61,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,132.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,130.35,448,,facility
AUTOMATED PLATELET COUNT,85049,CPT,305,RC,,,,outpatient,,,33,3.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,9.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.98,3.98,3.98,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.68,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,4.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,4.48,448,,facility
COLD AGGLUTININ TITER,86157,CPT,302,RC,,,,outpatient,,,16.5,1.65,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,16.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.41,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,8.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,8.06,448,,facility
PROTHROMBIN TIME,85610,CPT,305,RC,,,,outpatient,,,25,2.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.82,3.82,3.82,148,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,25.6,25.6,68.48,85,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,63.13,63.13,63.13,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,35.95,16.37,61.1,101,percent of total billed charges,,,33.6,,21.12,13.44,56.5,20,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,13.56,13.44,36.27,76,percent of total billed charges,,,34.6,,38.84,38.84,40.77,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,8.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,53.5,20,141,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,22.47,8.4,22.47,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.82,3.82,3.82,801,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.49,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,4.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,4.29,448,,facility
BLOOC CLOT FACTOR V TEST,85220,CPT,305,RC,,,,outpatient,,,311,31.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,36.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.7,15.7,15.7,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.13,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.65,448,,facility
THROMBIN TIME PLASMA,85670,CPT,305,RC,,,,outpatient,,,57,5.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,12.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.46,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.77,448,,facility
PROTEIN E-PHORESIS SERUM,84165,CPT,301,RC,,,,outpatient,,,15,1.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9.55,9.55,9.55,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,287.76,46.46,287.76,1 through 10,percent of total billed charges,,,33.6,,29.57,29.57,29.57,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,29.92,29.57,184.76,1 through 10,percent of total billed charges,,,34.6,,197.83,197.83,207.64,11,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,22.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9.55,9.55,9.55,33,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,23.21,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,10.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,10.74,448,,facility
ASSAY OF APOLIPOPROTEIN,82172,CPT,301,RC,,,,outpatient,,,32,3.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,18.76,18.76,18.76,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,22.18,20.16,31.68,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,20.16,20.16,20.34,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,21.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,44.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,18.76,18.76,18.76,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,21.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.91,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,21.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,21.09,448,,facility
ASSAY NEPHELOMETRY NOT SPEC,83883,CPT,301,RC,,,,outpatient,,,33.85,3.39,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.1,12.1,12.1,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,173.18,51.22,173.18,1 through 10,percent of total billed charges,,,33.6,,31.58,31.58,31.58,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,31.58,31.53,110.21,11,percent of total billed charges,,,34.6,,119.06,117.35,124.97,24,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,28.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.1,12.1,12.1,29,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.38,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.6,448,,facility
DETECT AGENT NOS DNA AMP,87798,CPT,306,RC,,,,outpatient,,,468,46.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,110.88,110.88,174.24,1 through 10,percent of total billed charges,,,33.6,,244.27,244.27,244.27,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,96.77,32.38,119.79,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,38.9,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
SC STD MYOBACTERIA PROP METH,87190,CPT,306,RC,,,,outpatient,,,53,5.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,7.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,15.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,7.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,7.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,7.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.79,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,7.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,7.31,448,,facility
ENZYME CELL ACTIVITY,82657,CPT,301,RC,,,,outpatient,,,109,10.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.72,19.72,19.72,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,2094.14,2094.14,2094.14,1 through 10,percent of total billed charges,,,33.6,,762.96,762.96,762.96,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,46.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,23.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.72,19.72,19.72,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,23.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,39.01,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,22.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,22.17,448,,facility
DRUG/SUBSTANCE NOS 4-6,80376,CPT,301,RC,,,,outpatient,,,402,40.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
CLOT INHIBIT PROT C ANTIGEN,85302,CPT,305,RC,,,,outpatient,,,45.75,4.58,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.68,10.68,10.68,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,90.05,90.05,90.05,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.68,10.68,81.75,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.95,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.01,448,,facility
APC GENE FULL SEQUENCE,81201,CPT,310,RC,,,,outpatient,,,298,29.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,780,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,780,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,803.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,780,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1630.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,826.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,780,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,826.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1365,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,795.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1630.2,,facility
WEST NILE VIRUS AB IGM,86788,CPT,302,RC,,,,outpatient,,,54.95,5.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,63.5,63.5,63.5,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,35.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,14.99,14.99,14.99,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.4,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,16.85,448,,facility
TEST FOR URINE CYSTINES,82615,CPT,301,RC,,,,outpatient,,,47,4.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,9.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,19.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,9.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.64,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,9.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,9.55,448,,facility
DIHYDROTESTOSTERONE,82642,CPT,301,RC,,,,outpatient,,,48.85,4.89,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,22.51,22.51,22.51,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,29.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,61.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,31.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,29.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,31.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,56.93,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,29.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,29.28,448,,facility
ASSAY OF URINE CREATININE,82570,CPT,301,RC,,,,outpatient,,,43,4.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.61,4.61,4.61,213,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,71.39,41.89,142.78,14,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,37.49,23.86,74.98,60,percent of total billed charges,,,33.6,,37.49,23.85,81.31,18,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,24.07,23.86,47.71,75,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,10.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,60.5,4.61,151,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,14.91,14.91,25.41,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,85.58,85.58,85.58,1 through 10,percent of total billed charges,,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.61,4.61,4.61,636,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.18,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.18,448,,facility
ANALGESICS NON-OPIOID 6/MORE,80331,CPT,301,RC,,,,outpatient,,,35,3.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
SMEAR FLUORESCENT/ACID STAI,87206,CPT,306,RC,,,,outpatient,,,52,5.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.79,4.79,4.79,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,11.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.79,4.79,4.79,21,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.64,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.39,448,,facility
ASSAY OF RENIN,84244,CPT,301,RC,,,,outpatient,,,38.5,3.85,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.56,19.56,19.56,13,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,24.19,24.19,63.13,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,21.65,13.78,21.65,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,13.78,13.78,35.95,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,21.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,45.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,23.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.56,19.56,19.56,29,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,21.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,23.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,47.51,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,22.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,21.99,448,,facility
MICROSOMAL ANTIBODY EACH,86376,CPT,302,RC,,,,outpatient,,,162,16.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.94,12.94,12.94,22,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,22.18,14.11,82.9,1 through 10,percent of total billed charges,,,33.6,,22.51,22.51,22.51,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,22.51,11.27,81.98,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,30.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.94,12.94,12.94,63,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,31.43,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.55,448,,facility
RBC PRETX INCUBATJ W/CHEMICL,86970,CPT,302,RC,,,,outpatient,,,130,13,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,56.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,56.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,58.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,145.56,145.56,145.56,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,56.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,118,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,59.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,56.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,59.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,55.65,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,57.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,55.65,448,,facility
DEHYDROEPIANDROSTERONE,82627,CPT,301,RC,,,,outpatient,,,41.2,4.12,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.77,19.77,19.77,24,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,44.25,44.25,44.25,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,39.6,39.6,142.03,1 through 10,percent of total billed charges,,,33.6,,25.2,25.2,25.2,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,25.2,25.2,90.38,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,46.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,23.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.77,19.77,19.77,42,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,23.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,48.04,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,22.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,22.23,448,,facility
FIBRINOGEN ACTIVITY,85384,CPT,305,RC,,,,outpatient,,,182,18.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,8.65,8.65,8.65,24,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,35.38,22.51,262.09,12,percent of total billed charges,,,33.6,,35.38,22.51,154.22,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,154.22,154.22,311.2,1 through 10,percent of total billed charges,,,34.6,,169.83,169.83,169.83,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,9.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,20.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,33.5,33.5,33.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,8.65,8.65,8.65,96,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,9.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.36,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,9.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,9.72,448,,facility
CHROMOGENIC SUBSTRATE ASSAY,85130,CPT,305,RC,,,,outpatient,,,591,59.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.58,10.58,10.58,11,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,571.12,571.12,571.12,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,277.2,277.2,277.2,1 through 10,percent of total billed charges,,,33.6,,176.4,176.4,176.4,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,24.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.58,10.58,10.58,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.69,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.89,448,,facility
DETECTION TEST BY IMMUNOASSAY TECHNIQUE FOR GIARDIA (INTESTINAL PARASITE),87329,CPT,0306,RC,,,,outpatient,,,42,4.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.9,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.98,448,,facility
ABL1 GENE,81170,CPT,310,RC,,,,outpatient,,,870,87,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,300,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,300,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,309,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,300,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,627,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,318,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,266.85,266.85,266.85,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,300,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,318,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,525,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,306,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,300,627,,facility
URINALYSIS VOLUME MEASURE,81050,CPT,307,RC,,,,outpatient,,,33,3.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.24,3.24,3.24,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,3.7,3.36,3.7,1 through 10,percent of total billed charges,,,33.6,,3.36,3.36,3.36,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,3.36,3.36,3.36,1 through 10,percent of total billed charges,,,34.6,,3.99,3.99,3.99,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,7.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.24,3.24,98.45,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.49,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,3.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,3.64,448,,facility
RHEUMATOID FACTOR QUANT,86431,CPT,302,RC,,,,outpatient,,,145,14.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.04,5.04,5.04,26,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,33.63,33.63,33.63,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,30.1,19.05,30.1,1 through 10,percent of total billed charges,,,33.6,,19.15,19.15,30.1,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,19.15,19.15,19.24,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,11.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.04,5.04,5.04,75,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.25,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.67,448,,facility
TOXOPLASMA ANTIBODY IGM,86778,CPT,302,RC,,,,outpatient,,,34,3.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.82,12.82,12.82,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,30.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.82,12.82,12.82,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,31.12,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.41,448,,facility
COOMBS TEST INDIRECT TITER,86886,CPT,302,RC,,,,outpatient,,,21.19,2.12,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,150.35,150.35,150.35,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,167.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,340.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,172.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.61,4.61,4.61,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,172.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.18,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,166.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.18,448,,facility
MOPATH PROCEDURE LEVEL 4,81403,CPT,310,RC,,,,outpatient,,,121,12.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,185.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,185.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,190.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,322.39,322.39,322.39,1 through 10,percent of total billed charges,,,34.6,,397.12,397.12,397.12,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,185.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,387.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,196.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,185.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,196.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,324.1,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,188.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,185.2,448,,facility
MUMPS ANTIBODY,86735,CPT,302,RC,,,,outpatient,,,19.28,1.93,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.61,11.61,11.61,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,22.18,22.18,85.01,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,68.61,68.61,68.61,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,44,44,44,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.61,11.61,11.61,15,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.19,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.05,448,,facility
ASSAY FOR PHENCYCLIDINE,83992,CPT,301,RC,,,,outpatient,,,60,6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.6,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,75.6,448,,facility
ACYLCARNITINES QUANT,82017,CPT,301,RC,,,,outpatient,,,25,2.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.01,15.01,15.01,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,279.84,279.84,279.84,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,35.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.01,15.01,15.01,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.45,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,16.87,448,,facility
HERPES SIMPLEX TYPE 2 TEST,86696,CPT,302,RC,,,,outpatient,,,20,2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,17.21,17.21,17.21,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,20.59,20.59,42.71,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,13.1,13.1,13.1,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,40.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,20.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,17.21,17.21,17.21,12,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,20.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,41.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,19.35,448,,facility
DNA ANTIBODY NATIVE,86225,CPT,302,RC,,,,outpatient,,,72,7.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.22,12.22,12.22,16,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,32.21,29.57,46.46,11,percent of total billed charges,,,33.6,,29.57,29.57,29.57,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,29.66,29.57,98.11,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,28.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.22,12.22,12.22,49,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.7,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.74,448,,facility
BORDETELLA ANTIBODY,86615,CPT,302,RC,,,,outpatient,,,41,4.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.73,11.73,11.73,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.49,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.19,448,,facility
PROCALCITONIN (PCT),84145,CPT,301,RC,,,,outpatient,,,75,7.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,24.21,24.21,24.21,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,182.72,107.52,215.04,1 through 10,percent of total billed charges,,,33.6,,99.54,99.54,107.52,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,107.52,33.6,108.48,15,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,27.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,56.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,28.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,160,160,160,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,24.21,24.21,24.21,349,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,27.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,28.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,57.89,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,27.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,27.22,448,,facility
ASSAY OF ASCORBIC ACID,82180,CPT,301,RC,,,,outpatient,,,36.1,3.61,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,52,52,52,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,9.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,20.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,26,26,26,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,21.42,21.42,21.42,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,8.8,8.8,8.8,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,9.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.35,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,10.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,9.89,448,,facility
OPIOIDS & OPIATE ANALOGS 1/2,80362,CPT,301,RC,,,,outpatient,,,70,7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
ENCEPHALTIS WEST EQNE ANTBDY,86654,CPT,302,RC,,,,outpatient,,,80,8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.49,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.19,448,,facility
ANTIPSYCHOTICS NOS 7/MORE,80344,CPT,301,RC,,,,outpatient,,,35,3.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
MSH2 GENE DUP/DELETE VARIANT,81297,CPT,310,RC,,,,outpatient,,,150,15,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,213.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,213.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,219.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,213.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,445.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,226.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,213.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,226.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,373.28,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,217.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,213.3,448,,facility
ASSAY OF TOTAL THYROXINE,84436,CPT,301,RC,,,,outpatient,,,31,3.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,6.11,6.11,6.11,16,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,29.04,18.48,252.95,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,18.56,18.48,150.18,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,14.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,7.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,6.11,6.11,6.11,40,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,7.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.84,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,7.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,6.87,448,,facility
MLH1 GENE DUP/DELETE VARIANT,81294,CPT,310,RC,,,,outpatient,,,143,14.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,202.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,202.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,208.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,202.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,423.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,214.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,202.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,214.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,354.2,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,206.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,202.4,448,,facility
ASSAY OF LIPOPROTEIN,83718,CPT,301,RC,,,,outpatient,,,40,4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,7.28,7.28,7.28,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,17.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.71,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,8.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,8.19,448,,facility
UNLISTED MOLECULAR PATHOLOGY,81479,CPT,310,RC,,,,outpatient,,,725,72.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,561.56,561.56,561.56,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,32.5,32.5,3071.5,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
RIA NONANTIBODY,83519,CPT,301,RC,,,,outpatient,,,65,6.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,55.44,55.44,55.44,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.37,16.37,16.37,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.2,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.4,448,,facility
BRCA1&2 GEN FULL SEQ DUP/DEL,81162,CPT,310,RC,,,,outpatient,,,664,66.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1824.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1824.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1879.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1824.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3814,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1934.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1824.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1934.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3942.63,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1861.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3942.63,,facility
TREPONEMA PALLIDUM,86780,CPT,302,RC,,,,outpatient,,,35.75,3.58,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.78,11.78,11.78,612,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,10.62,10.62,50.15,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,9.5,6.05,48.53,46,percent of total billed charges,,,33.6,,6.05,6.05,44.88,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,6.05,6.05,28.56,66,percent of total billed charges,,,34.6,,73.69,20.19,77.34,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,9,9,42.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,17.85,17.85,17.85,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,11.78,11.78,11.78,1 through 10,percent of total billed charges,,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.78,11.78,11.78,550,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.6,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.24,448,,facility
ASSAY OF URINE CREATININE,82570,CPT,301,RC,,,,outpatient,,,7,0.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.61,4.61,4.61,213,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,71.39,41.89,142.78,14,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,37.49,23.86,74.98,60,percent of total billed charges,,,33.6,,37.49,23.85,81.31,18,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,24.07,23.86,47.71,75,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,10.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,60.5,4.61,151,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,14.91,14.91,25.41,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,85.58,85.58,85.58,1 through 10,percent of total billed charges,,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.61,4.61,4.61,636,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.18,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.18,448,,facility
NUCLEAR ANTIGEN ANTIBODY,86235,CPT,302,RC,,,,outpatient,,,138,13.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13,12.5,15.95,11,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,54.91,4.37,90.29,43,percent of total billed charges,,,33.6,,4.37,4.37,53.09,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,22.18,4.24,83.33,13,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,37.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.95,13,15.95,54,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.75,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.93,448,,facility
HEMATOCRIT,85014,CPT,305,RC,,,,outpatient,,,33,3.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,2.11,2.11,2.11,26,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,12.16,12.16,78.72,14,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,3.32,3.32,11.21,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,68.24,41.33,70.23,31,percent of total billed charges,,,33.6,,10.03,10.03,41.33,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,41.33,6.38,41.7,26,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,4.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,61.5,9.5,61.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,2.11,2.11,2.11,164,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.13,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,2.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,2.37,448,,facility
ASSAY TRIIODOTHYRONINE (T3),84480,CPT,301,RC,,,,outpatient,,,36,3.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.61,12.61,12.61,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,19.85,19.85,19.85,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,12.77,12.77,71.23,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,19.26,12.77,71.23,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,29.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.61,12.61,12.61,15,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.64,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.18,448,,facility
ASSAY SERUM CHOLINESTERASE,82480,CPT,301,RC,,,,outpatient,,,28.55,2.86,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,7.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,16.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,7.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.01,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,8.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,7.87,448,,facility
HEMOGLOBIN CHROMOTOGRAPHY,83021,CPT,301,RC,,,,outpatient,,,131,13.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.06,16.06,16.06,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,37.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,58.38,58.38,58.38,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.06,16.06,16.06,16,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,39.01,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.06,448,,facility
ASSAY OF AMYLASE,82150,CPT,301,RC,,,,outpatient,,,8,0.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.76,5.76,5.76,19,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,95,95,95,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,54.24,31.92,54.25,46,percent of total billed charges,,,33.6,,31.92,27.12,54.24,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,31.92,27.12,31.92,11,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,13.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,40,40,47.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.76,5.76,5.76,306,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,6.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,6.48,448,,facility
MOPATH PROCEDURE LEVEL 3,81402,CPT,310,RC,,,,outpatient,,,515,51.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,150.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,150.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,154.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,150.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,314.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,159.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,150.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,159.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,263.08,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,153.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,150.33,448,,facility
BASIC METABOLIC PNL TOTAL CA,80048,CPT,301,RC,,,,outpatient,,,8.5,0.85,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,7.53,7.53,7.53,173,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,25.96,11.84,443.68,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,28.16,28.16,28.16,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,254.93,23.23,429.39,147,percent of total billed charges,,,33.6,,252.67,14.78,429.39,26,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,14.92,14.78,252.67,149,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,17.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,22,22,376,21,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,9.24,9.24,157.92,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,7.53,7.53,7.53,1135,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.27,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,8.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,8.46,448,,facility
ASSAY OF VOLATILES,84600,CPT,301,RC,,,,outpatient,,,30,3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,35.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,34.74,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.11,448,,facility
QUANTITATIVE ASSAY DRUG,80299,CPT,301,RC,,,,outpatient,,,62.8,6.28,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,13,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,174.64,174.64,174.64,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,171.6,171.6,171.6,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,374.52,374.52,374.52,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.62,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.64,448,,facility
LYMPHOCYTE TRANSFORMATION,86353,CPT,302,RC,,,,outpatient,,,484,48.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,49.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,49.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,50.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,49.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,102.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,51.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,49.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,51.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,105.93,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,50.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,49.03,448,,facility
UNLISTED MOLECULAR PATHOLOGY,81479,CPT,310,RC,,,,outpatient,,,248,24.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,561.56,561.56,561.56,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,32.5,32.5,3071.5,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
ENCEPHALTIS ST LOUIS ANTBODY,86653,CPT,302,RC,,,,outpatient,,,80,8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.49,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.19,448,,facility
OPIATES 1 OR MORE,80361,CPT,301,RC,,,,outpatient,,,35,3.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
METHYLENEDIOXYAMPHETAMINES,80359,CPT,301,RC,,,,outpatient,,,119,11.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
TOXOPLASMA ANTIBODY IGM,86778,CPT,302,RC,,,,outpatient,,,151,15.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.82,12.82,12.82,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,30.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.82,12.82,12.82,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,31.12,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.41,448,,facility
ELECTRON MICROSCOPY DX,88348,CPT,310,RC,,,,outpatient,,,1842,184.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,716.75,711.24,771.08,14,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,2202.88,1496.32,2202.88,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,771.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,771.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,794.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,771.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1611.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,817.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,337.34,337.34,341.35,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,771.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,817.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,946.68,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,786.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1611.56,,facility
THROMBIN TIME PLASMA,85670,CPT,305,RC,,,,outpatient,,,31,3.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,12.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.46,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.77,448,,facility
HEXAGNAL PHOSPH PLTLT NEUTRL,85598,CPT,305,RC,,,,outpatient,,,158,15.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.99,15.99,15.99,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,168.32,168.32,168.32,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,37.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.98,448,,facility
GENE ANALYSIS (HEMOCHROMATOSIS) COMMON VARIANTS,81256,CPT,0310,RC,,,,outpatient,,,260,26,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,58.14,58.14,58.14,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,65.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,65.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,67.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,65.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,136.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,69.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,65.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,69.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,141.21,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,66.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,65.36,448,,facility
ASSAY OF HAPTOGLOBIN QUANT,83010,CPT,301,RC,,,,outpatient,,,37.29,3.73,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.19,11.19,11.19,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,143.09,143.09,143.09,21,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,31.92,31.92,91.06,1 through 10,percent of total billed charges,,,34.6,,98.37,98.37,98.37,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,26.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,56.91,56.91,56.91,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.19,11.19,11.19,23,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.18,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.58,448,,facility
ASSAY OF ARSENIC,82175,CPT,301,RC,,,,outpatient,,,55,5.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.87,16.87,16.87,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,39.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,20.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.87,16.87,16.87,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,20.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,40.99,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.97,448,,facility
T CELLS TOTAL COUNT,86359,CPT,302,RC,,,,outpatient,,,192,19.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,33.56,33.56,33.56,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,37.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,37.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,82.68,82.68,82.68,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,78.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,39.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,33.56,33.56,33.56,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,39.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,81.52,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,38.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,37.73,448,,facility
OVA AND PARASITES SMEARS,87177,CPT,306,RC,,,,outpatient,,,22,2.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,7.92,7.92,7.92,19,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,60.8,60.8,205.44,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,50.16,31.92,50.16,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,31.92,31.92,31.92,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,18.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,9.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,7.92,7.92,7.92,21,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,9.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.23,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,9.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,8.9,448,,facility
MLH1 GENE FULL SEQ,81292,CPT,310,RC,,,,outpatient,,,262,26.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,675.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,675.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,695.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,675.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1411.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,715.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,675.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,715.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1181.95,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,688.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1411.59,,facility
BLD TYPING SEROLOGIC RH PHNT,86906,CPT,305,RC,,,,outpatient,,,67,6.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,74.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.75,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,36.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,16.75,448,,facility
FIBRINOLYTIC PLASMINOGEN,85415,CPT,305,RC,,,,outpatient,,,56.25,5.63,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.29,15.29,15.29,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,35.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.29,15.29,15.29,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,37.14,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.19,448,,facility
ASSAY OF NUCLEOTIDASE,83915,CPT,301,RC,,,,outpatient,,,69,6.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,23.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.1,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,11.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.15,448,,facility
RICKETTSIA ANTIBODY,86757,CPT,302,RC,,,,outpatient,,,170,17,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,17.21,17.21,17.21,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,40.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,20.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,17.21,17.21,17.21,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,20.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,41.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,19.35,448,,facility
MUMPS ANTIBODY,86735,CPT,302,RC,,,,outpatient,,,107,10.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.61,11.61,11.61,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,22.18,22.18,85.01,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,68.61,68.61,68.61,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,44,44,44,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.61,11.61,11.61,15,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.19,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.05,448,,facility
PATH CONSLTJ SURG CYTO XM 1,88333,CPT,310,RC,,,,outpatient,,,41,4.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,771.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,771.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,794.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,341.69,341.69,341.69,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,198.32,198.32,198.32,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,771.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1611.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,817.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,25.34,25.34,25.34,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,771.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,817.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,946.68,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,786.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1611.56,,facility
ASSAY OF LEAD,83655,CPT,301,RC,,,,outpatient,,,12.5,1.25,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.77,10.77,10.77,70,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,47.79,47.79,47.79,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,27.22,27.22,42.77,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,11.76,11.76,27.22,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,40.5,40.5,40.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.77,10.77,10.77,84,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.16,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.11,448,,facility
HYDROXYINDOLACETIC ACID (PRODUCT OF METABOLISM) LEVEL,83497,CPT,0301,RC,,,,outpatient,,,37,3.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,26.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.86,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.9,448,,facility
ASSAY OF SELENIUM,84255,CPT,301,RC,,,,outpatient,,,63.8,6.38,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,22.71,22.71,22.71,14,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,46.99,46.99,46.99,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,25.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,53.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,27.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,22.71,22.71,22.71,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,25.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,27.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,55.16,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,26.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,25.53,448,,facility
TISS TRNSGLTMNASE EA IG CLAS,86364,CPT,302,RC,,,,outpatient,,,31,3.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9,9,10.26,36,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,10.62,10.62,55.46,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,9.5,6.1,38.02,36,percent of total billed charges,,,33.6,,6.05,6.05,6.05,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,6.05,6.05,6.1,19,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,24.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,9,9,9,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9,9,10.26,141,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.18,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,11.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.53,448,,facility
QUANTITATIVE ASSAY DRUG,80299,CPT,301,RC,,,,outpatient,,,226.25,22.63,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,13,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,174.64,174.64,174.64,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,171.6,171.6,171.6,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,374.52,374.52,374.52,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.62,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.64,448,,facility
KETAMINE AND NORKETAMINE,80357,CPT,301,RC,,,,outpatient,,,40,4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
ASSAY OF TOTAL TESTOSTERONE,84403,CPT,301,RC,,,,outpatient,,,10,1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,22.96,20,22.96,75,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,44.84,11.8,294.41,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,35.9,10.56,263.47,33,percent of total billed charges,,,33.6,,40.13,25.54,169.16,16,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,25.54,6.72,167.66,56,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,25.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,53.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,27.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,38,38,38,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,4.2,4.2,4.2,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,22.96,20,22.96,116,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,25.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,27.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,55.77,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,26.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,25.81,448,,facility
MICROSOMAL ANTIBODY EACH,86376,CPT,302,RC,,,,outpatient,,,48,4.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.94,12.94,12.94,22,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,22.18,14.11,82.9,1 through 10,percent of total billed charges,,,33.6,,22.51,22.51,22.51,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,22.51,11.27,81.98,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,30.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.94,12.94,12.94,63,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,31.43,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.55,448,,facility
ASSAY OF CAROTENE,82380,CPT,301,RC,,,,outpatient,,,40.25,4.03,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,9.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,19.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,9.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,9.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,9.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.93,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,9.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,9.22,448,,facility
ENCEPHALTIS EAST EQNE ANBDY,86652,CPT,302,RC,,,,outpatient,,,43,4.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.49,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.19,448,,facility
DRUG ASSAY VEDOLIZUMAB,80280,CPT,301,RC,,,,outpatient,,,486,48.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,39.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,38.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,80.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,40.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,38.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,40.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,67.5,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,39.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,38.57,448,,facility
GENOME SEQUENCE ANALYSIS,81425,CPT,310,RC,,,,outpatient,,,4719,471.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5031.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5031.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5182.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5031.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,10515.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5333.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5031.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5333.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8804.6,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5131.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,10515.21,,facility
ASSAY OF UREA NITROGEN,84520,CPT,301,RC,,,,outpatient,,,15,1.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.51,3.51,3.51,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,7.9,7.9,7.9,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,37.69,22.18,37.69,1 through 10,percent of total billed charges,,,33.6,,22.18,22.18,22.18,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,22.18,19.49,43.73,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,8.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.51,3.51,3.51,46,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.54,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,4.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,3.95,448,,facility
MOPATH PROCEDURE LEVEL 6,81405,CPT,310,RC,,,,outpatient,,,495,49.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,301.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,301.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,310.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,301.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,629.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,319.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,301.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,319.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,527.36,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,307.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,301.35,629.82,,facility
LEPTOSPIRA ANTIBODY,86720,CPT,302,RC,,,,outpatient,,,90,9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,33.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.49,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,16.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,16.2,448,,facility
UNLISTED MOLECULAR PATHOLOGY,81479,CPT,310,RC,,,,outpatient,,,23.5,2.35,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,561.56,561.56,561.56,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,32.5,32.5,3071.5,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
IMMUNOASSAY QUANT NOS NONAB,83520,CPT,301,RC,,,,outpatient,,,300,30,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,36,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,66.08,66.08,66.08,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,41.18,24.82,318.38,1 through 10,percent of total billed charges,,,33.6,,37.63,37.63,96.43,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,33.6,23.18,176.4,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,36.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,87,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.22,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.27,448,,facility
VIRUS ANTIBODY NOS,86790,CPT,302,RC,,,,outpatient,,,81.75,8.18,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.46,11.46,11.46,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,107.86,20.06,169.49,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,116.52,40.29,122.3,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,26.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.46,11.46,11.46,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.88,448,,facility
EHRLICHIA ANTIBODY,86666,CPT,302,RC,,,,outpatient,,,169,16.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,7.53,7.53,7.53,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,21.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9.05,9.05,9.05,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.98,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,10.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,10.18,448,,facility
ASSAY OF QUINIDINE,80194,CPT,301,RC,,,,outpatient,,,20,2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,30.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,31.55,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.6,448,,facility
RUBEOLA ANTIBODY,86765,CPT,302,RC,,,,outpatient,,,65,6.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.46,11.46,11.46,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,22.18,22.18,83.95,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,20.68,20.68,20.68,1 through 10,percent of total billed charges,,,34.6,,61.35,61.35,61.35,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,26.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,44,44,44,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.46,11.46,11.46,18,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.88,448,,facility
CULTURE ANAEROBE IDENT EACH,87076,CPT,306,RC,,,,outpatient,,,15,1.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,16.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,334.5,334.5,334.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,7.19,7.19,14.38,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.45,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,8.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,8.08,448,,facility
DRUG/SUBSTANCE NOS 4-6,80376,CPT,301,RC,,,,outpatient,,,43,4.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
ANTINOMYCES ANTIBODY,86602,CPT,302,RC,,,,outpatient,,,40,4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,21.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.98,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,10.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,10.18,448,,facility
DRUG SCREEN QUAN LAMOTRIGINE,80175,CPT,301,RC,,,,outpatient,,,34,3.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.79,11.79,11.79,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,31.15,31.15,57.67,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,29.5,29.5,29.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.79,11.79,11.79,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.63,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.25,448,,facility
COMPLEMENT ANTIGEN,86160,CPT,302,RC,,,,outpatient,,,43,4.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.67,10.67,10.67,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,87.32,87.32,87.32,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,78.14,49.73,270.86,17,percent of total billed charges,,,33.6,,49.73,49.73,172.37,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,49.73,29.23,50.32,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,256.5,256.5,256.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.67,10.67,10.67,61,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.92,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12,448,,facility
CHROMOGENIC SUBSTRATE ASSAY,85130,CPT,305,RC,,,,outpatient,,,515,51.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.58,10.58,10.58,11,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,571.12,571.12,571.12,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,277.2,277.2,277.2,1 through 10,percent of total billed charges,,,33.6,,176.4,176.4,176.4,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,24.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.58,10.58,10.58,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.69,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.89,448,,facility
ASSAY OF GLUCAGON,82943,CPT,301,RC,,,,outpatient,,,54.1,5.41,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,29.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.87,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.29,448,,facility
QUANTITATIVE ASSAY DRUG,80299,CPT,301,RC,,,,outpatient,,,200,20,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,13,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,174.64,174.64,174.64,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,171.6,171.6,171.6,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,374.52,374.52,374.52,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.62,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.64,448,,facility
ASSAY OF 5-HIAA,83497,CPT,301,RC,,,,outpatient,,,37.5,3.75,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,26.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.86,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.9,448,,facility
HLA I TYPING COMPLETE HR,81379,CPT,300,RC,,,,outpatient,,,687,68.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,335.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,335.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,345.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,335.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,700.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,355.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,335.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,355.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,724.59,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,342.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,335.38,724.59,,facility
ASSAY OF VITAMIN B-1,84425,CPT,301,RC,,,,outpatient,,,42.5,4.25,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,18.88,18.88,18.88,41,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,39.83,39.83,39.83,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,35.9,35.64,35.9,1 through 10,percent of total billed charges,,,33.6,,22.88,22.88,22.88,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,22.85,22.85,22.88,16,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,21.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,44.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,18.88,18.88,18.88,118,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,21.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,45.87,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,21.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,21.23,448,,facility
M. GENITALIUM AMP PROBE,87563,CPT,306,RC,,,,outpatient,,,228,22.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,61.41,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
PHENOTYPE DNA HIV W/CLT ADD,87904,CPT,306,RC,,,,outpatient,,,34.7,3.47,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,26.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,54.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,27.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,26.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,27.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,56.32,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,26.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,26.07,448,,facility
ASSAY NONENDOCRINE RECEPTOR,84238,CPT,301,RC,,,,outpatient,,,50,5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,37.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,36.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,76.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,38.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,36.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,38.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,79,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,37.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,36.57,448,,facility
IMMUNOASSAY QUANT NOS NONAB,83520,CPT,301,RC,,,,outpatient,,,66,6.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,36,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,66.08,66.08,66.08,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,41.18,24.82,318.38,1 through 10,percent of total billed charges,,,33.6,,37.63,37.63,96.43,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,33.6,23.18,176.4,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,36.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,87,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.22,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.27,448,,facility
TRICHOMONAS VAGINALIS AMPLIF,87661,CPT,306,RC,,,,outpatient,,,197,19.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,57,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,127.44,127.44,127.44,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,114.05,72.58,123.34,1 through 10,percent of total billed charges,,,33.6,,28.9,28.9,114.05,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,72.58,28.9,73.22,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,91,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
BODY FLUID CELL COUNT,89050,CPT,300,RC,,,,outpatient,,,214,21.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,271.36,271.36,271.36,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,142.46,142.46,190.38,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,9.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,89.04,89.04,89.04,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.2,4.2,4.2,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.2,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,4.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,4.72,448,,facility
THROMBOPLASTIN TIME PARTIAL,85732,CPT,305,RC,,,,outpatient,,,31,3.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.75,5.75,5.75,18,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,24.29,15.46,83.95,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,15.46,15.46,15.46,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,13.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.75,5.75,5.75,33,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.97,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,6.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,6.47,448,,facility
PROTHROMBIN TEST,85611,CPT,305,RC,,,,outpatient,,,35,3.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,8.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.52,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,4.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,3.94,448,,facility
BLOOD SPLIT UNIT,P9011,HCPCS,390,RC,,,,outpatient,,,115,11.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,141.8,130.8,155.08,21,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,558.72,558.72,558.72,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,155.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,155.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,159.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,155.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,324.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,164.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,155.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,164.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,107,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,158.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,107,448,,facility
ASSAY OF PROINSULIN,84206,CPT,301,RC,,,,outpatient,,,61.85,6.19,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,26.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,55.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,28.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,26.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,28.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,46.71,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,27.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,26.69,448,,facility
IMMUNOASSAY QUANT NOS NONAB,83520,CPT,301,RC,,,,outpatient,,,144,14.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,36,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,66.08,66.08,66.08,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,41.18,24.82,318.38,1 through 10,percent of total billed charges,,,33.6,,37.63,37.63,96.43,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,33.6,23.18,176.4,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,36.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,87,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.22,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.27,448,,facility
CYTOMEG DNA AMP PROBE,87496,CPT,306,RC,,,,outpatient,,,275,27.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
CLOSTRIDIUM AG IA,87324,CPT,306,RC,,,,outpatient,,,50,5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.9,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.98,448,,facility
ASSAY OF MYOGLOBIN,83874,CPT,301,RC,,,,outpatient,,,33.1,3.31,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.49,11.49,11.49,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.91,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.92,448,,facility
DETECT AGENT NOS DNA AMP,87798,CPT,306,RC,,,,outpatient,,,147,14.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,110.88,110.88,174.24,1 through 10,percent of total billed charges,,,33.6,,244.27,244.27,244.27,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,96.77,32.38,119.79,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,38.9,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
BLOOC CLOT FACTOR V TEST,85220,CPT,305,RC,,,,outpatient,,,85.5,8.55,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,36.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.7,15.7,15.7,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.13,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.65,448,,facility
ALANINE AMINO (ALT) (SGPT),84460,CPT,301,RC,,,,outpatient,,,4,0.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.71,4.71,4.71,14,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,391,391,391,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,223.26,61.13,223.26,47,percent of total billed charges,,,33.6,,131.38,131.38,223.26,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,131.38,20.5,132.55,20,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,11.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,195.5,195.5,195.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.71,4.71,4.71,309,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.45,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.3,448,,facility
CHLAMYDIA ANTIBODY,86631,CPT,302,RC,,,,outpatient,,,22.5,2.25,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,24.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.55,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.82,448,,facility
HSV DNA AMP PROBE,87529,CPT,306,RC,,,,outpatient,,,155,15.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,244.61,244.61,244.61,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
AMINO ACIDS SINGLE QUANT,82131,CPT,301,RC,,,,outpatient,,,306,30.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,23.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,48.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,24.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,24.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,40.22,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,23.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,22.98,448,,facility
ASSAY OF URINE/UREA-N,84540,CPT,301,RC,,,,outpatient,,,38,3.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,91.87,91.87,91.87,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,11.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,135.5,135.5,135.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.95,4.95,4.95,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.26,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.56,448,,facility
ASSAY OF SEROTONIN,84260,CPT,301,RC,,,,outpatient,,,49.25,4.93,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,31.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,30.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,64.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,32.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,30.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,32.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,66.94,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,31.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,30.98,448,,facility
ASSAY FOR PHENCYCLIDINE,83992,CPT,301,RC,,,,outpatient,,,40,4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.6,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,75.6,448,,facility
DETECT AGNT MULT DNA AMPLI,87801,CPT,306,RC,,,,outpatient,,,891,89.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,70.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,70.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,72.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,70.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,146.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,74.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,62.44,62.44,62.44,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,70.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,74.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,151.66,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,71.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,70.2,448,,facility
DETECT AGENT NOS DNA AMP,87798,CPT,306,RC,,,,outpatient,,,163,16.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,110.88,110.88,174.24,1 through 10,percent of total billed charges,,,33.6,,244.27,244.27,244.27,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,96.77,32.38,119.79,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,38.9,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
QUANTITATIVE ASSAY DRUG,80299,CPT,301,RC,,,,outpatient,,,127.5,12.75,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,13,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,174.64,174.64,174.64,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,171.6,171.6,171.6,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,374.52,374.52,374.52,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.62,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.64,448,,facility
ANGIOTENSIN I ENZYME TEST,82164,CPT,301,RC,,,,outpatient,,,16,1.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.99,12.99,12.99,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,42.67,12.77,67.06,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,42.88,42.88,42.88,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,30.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.99,12.99,12.99,26,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,31.55,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.6,448,,facility
BILE ACIDS TOTAL,82239,CPT,301,RC,,,,outpatient,,,36.9,3.69,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.23,15.23,15.23,11,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,21.02,21.02,87.36,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,35.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,31,31,31,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.23,15.23,15.23,20,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,37,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.12,448,,facility
ASSAY OF QUININE,84228,CPT,301,RC,,,,outpatient,,,205,20.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,24.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.13,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,11.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.63,448,,facility
COL CHROMOTOGRAPHY QUAL/QUAN,82542,CPT,301,RC,,,,outpatient,,,53.5,5.35,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,21.43,21.43,21.43,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,435.07,435.07,435.07,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,24.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,50.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,25.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,21.43,21.43,21.43,15,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,24.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,25.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.16,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,24.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,24.09,448,,facility
SEDATIVE HYPNOTICS,80368,CPT,301,RC,,,,outpatient,,,40,4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
FACTOR INHIBITOR TEST,85335,CPT,305,RC,,,,outpatient,,,619,61.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.45,11.45,11.45,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,598.85,598.85,598.85,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,26.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.45,11.45,11.45,14,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.81,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.87,448,,facility
ASSAY ACTIVATED PROTEIN C,85307,CPT,305,RC,,,,outpatient,,,56.5,5.65,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,32.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.63,13.63,13.63,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,33.11,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,15.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,15.32,448,,facility
NUCLEAR ANTIGEN ANTIBODY,86235,CPT,302,RC,,,,outpatient,,,174,17.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13,12.5,15.95,11,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,54.91,4.37,90.29,43,percent of total billed charges,,,33.6,,4.37,4.37,53.09,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,22.18,4.24,83.33,13,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,37.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.95,13,15.95,54,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.75,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.93,448,,facility
IMMUNOASSAY NONANTIBODY,83516,CPT,301,RC,,,,outpatient,,,116,11.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9,9,10.26,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,4.75,4.75,218.59,30,percent of total billed charges,,,33.6,,3.02,3.02,175.39,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,3.02,3.02,211.68,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,24.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,23.5,23.5,23.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9,9,10.26,51,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.92,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,11.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.53,448,,facility
ASY HYDROXYPROGESTERONE 17-D,83498,CPT,301,RC,,,,outpatient,,,65,6.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,24.17,24.17,24.17,28,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,27.14,27.14,27.14,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,37.17,36.96,302.02,1 through 10,percent of total billed charges,,,33.6,,23.52,23.52,23.52,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,23.52,15.46,96.1,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,27.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,56.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,28.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,24.17,24.17,24.17,45,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,27.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,28.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,58.7,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,27.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,27.17,448,,facility
CHLAMYDIA CULTURE,87110,CPT,306,RC,,,,outpatient,,,35,3.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,40.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,20.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,20.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.33,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,19.6,448,,facility
ASSAY 17- KETOSTEROIDS,83586,CPT,301,RC,,,,outpatient,,,58,5.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,26.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.65,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.8,448,,facility
ENZYME CELL ACTIVITY,82657,CPT,301,RC,,,,outpatient,,,257.6,25.76,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.72,19.72,19.72,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,2094.14,2094.14,2094.14,1 through 10,percent of total billed charges,,,33.6,,762.96,762.96,762.96,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,46.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,23.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.72,19.72,19.72,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,23.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,39.01,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,22.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,22.17,448,,facility
PARTICLE AGGLUT ANTBDY SCRN,86403,CPT,302,RC,,,,outpatient,,,218.85,21.89,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,154.18,154.18,154.18,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,24.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.26,10.26,10.26,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.02,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,11.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.54,448,,facility
LYME DISEASE ANTIBODY,86618,CPT,302,RC,,,,outpatient,,,91,9.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,35.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.15,15.15,15.15,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.79,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.03,448,,facility
QUANTITATIVE ASSAY DRUG,80299,CPT,301,RC,,,,outpatient,,,58.95,5.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,13,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,174.64,174.64,174.64,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,171.6,171.6,171.6,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,374.52,374.52,374.52,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.62,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.64,448,,facility
METHYLENEDIOXYAMPHETAMINES,80359,CPT,301,RC,,,,outpatient,,,35,3.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
MOPATH PROCEDURE LEVEL 5,81404,CPT,310,RC,,,,outpatient,,,308,30.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,274.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,274.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,283.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,274.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,574.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,291.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,274.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,291.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,480.95,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,280.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,274.83,574.39,,facility
ORGANIC ACID SINGLE QUANT,83921,CPT,301,RC,,,,outpatient,,,68.65,6.87,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,18.87,18.87,18.87,11,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,60.72,38.64,203.28,1 through 10,percent of total billed charges,,,33.6,,129.36,129.36,129.36,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,38.64,38.64,38.9,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,21.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,44.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,57.38,57.38,57.38,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,18.87,18.87,18.87,21,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,21.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,37.12,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,21.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,21.21,448,,facility
ASPERGILLUS AG IA,87305,CPT,306,RC,,,,outpatient,,,150,15,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.66,10.66,10.66,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,82.9,82.9,82.9,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,86.68,86.68,86.68,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.66,10.66,10.66,16,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.9,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.98,448,,facility
CANNABINOIDS NATURAL,80349,CPT,301,RC,,,,outpatient,,,528,52.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
BLOOD TYPING SEROLOGIC ABO,86900,CPT,302,RC,,,,outpatient,,,20,2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,113.1,113.1,127.33,523,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,207.68,21.24,207.68,13,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,131.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,118.27,18.88,200.99,116,percent of total billed charges,,,33.6,,118.27,18.88,118.27,44,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,118.27,12.1,134.11,78,percent of total billed charges,,,34.6,,130.24,127.78,134.11,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,266.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,134.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,176,17.88,176,13,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,73.92,7.56,73.92,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,2.66,2.66,2.66,1 through 10,percent of total billed charges,,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,2.66,2.66,2.66,824,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,134.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.46,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,129.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,6.46,448,,facility
ANTISTREPTOLYSIN O TITER,86060,CPT,302,RC,,,,outpatient,,,18,1.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,40.99,40.99,40.99,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,7.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,15.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,7.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,6.49,6.49,6.49,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,7.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,7.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.77,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,7.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,7.3,448,,facility
EXOME SEQUENCE ANALYSIS,81415,CPT,310,RC,,,,outpatient,,,897,89.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4780,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4780,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4923.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4780,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,9990.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5066.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4780,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5066.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8365,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,4875.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,9990.2,,facility
RIA NONANTIBODY,83519,CPT,301,RC,,,,outpatient,,,92.5,9.25,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,55.44,55.44,55.44,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.37,16.37,16.37,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.2,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.4,448,,facility
DETECT AGENT NOS DNA AMP,87798,CPT,306,RC,,,,outpatient,,,125,12.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,110.88,110.88,174.24,1 through 10,percent of total billed charges,,,33.6,,244.27,244.27,244.27,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,96.77,32.38,119.79,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,38.9,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
ISLET CELL ANTIBODY,86341,CPT,302,RC,,,,outpatient,,,100,10,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,20.97,20.97,20.97,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,23.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,23.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,143.62,143.62,326.83,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,258.38,258.38,258.38,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,23.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,49.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,24.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,20.97,20.97,20.97,14,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,23.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,24.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.75,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,24.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,23.57,448,,facility
ASSAY OF LEAD,83655,CPT,301,RC,,,,outpatient,,,35,3.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.77,10.77,10.77,70,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,47.79,47.79,47.79,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,27.22,27.22,42.77,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,11.76,11.76,27.22,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,40.5,40.5,40.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.77,10.77,10.77,84,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.16,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.11,448,,facility
DRUG SCREENING FENTANYL,80354,CPT,301,RC,,,,outpatient,,,63,6.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
AUTOMATED RETICULOCYTE COUNT,85045,CPT,305,RC,,,,outpatient,,,7,0.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.55,3.55,3.55,82,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,112.46,16.13,112.46,40,percent of total billed charges,,,33.6,,16.13,16.13,16.13,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,16.13,16.13,71.57,12,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,8.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,24,23.88,24,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,44.73,44.73,44.73,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.55,3.55,3.55,284,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.63,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,4.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,3.99,448,,facility
BODY FLUID CELL COUNT,89051,CPT,309,RC,,,,outpatient,,,14,1.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,503.78,376.99,592.42,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,11.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.98,4.98,4.98,47,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.9,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.6,448,,facility
MASS SPECTROMETRY QUAL/QUAN,83789,CPT,301,RC,,,,outpatient,,,255,25.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,24.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,50.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,25.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,24.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,25.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.19,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,24.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,24.11,448,,facility
CFTR GENE COM VARIANTS,81220,CPT,310,RC,,,,outpatient,,,318,31.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,495.09,495.09,495.09,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,556.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,556.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,573.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,1875.98,1875.98,1875.98,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,1193.81,1193.81,1204.47,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,556.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1163.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,590,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,495.09,495.09,495.09,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,556.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,590,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,974.05,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,567.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1163.29,,facility
IMMUNOASSAY NONANTIBODY,83516,CPT,301,RC,,,,outpatient,,,147,14.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9,9,10.26,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,4.75,4.75,218.59,30,percent of total billed charges,,,33.6,,3.02,3.02,175.39,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,3.02,3.02,211.68,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,24.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,23.5,23.5,23.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9,9,10.26,51,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.92,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,11.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.53,448,,facility
RBC SERUM PRETX ID DILUTION,86976,CPT,302,RC,,,,outpatient,,,130,13,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,27.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,57.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,29.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,27.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,29.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.57,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,28.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,27.68,448,,facility
LYME DISEASE ANTIBODY,86618,CPT,302,RC,,,,outpatient,,,287,28.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,35.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.15,15.15,15.15,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.79,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.03,448,,facility
RIA NONANTIBODY,83519,CPT,301,RC,,,,outpatient,,,56,5.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,55.44,55.44,55.44,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.37,16.37,16.37,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.2,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.4,448,,facility
HLA II TYPING 1 LOCUS LR,81376,CPT,310,RC,,,,outpatient,,,110.3,11.03,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,122.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,122.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,125.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,122.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,255.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,129.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,122.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,129.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,264.06,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,124.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,122.22,448,,facility
FLUORESCENT ANTIBODY SCREEN,86255,CPT,302,RC,,,,outpatient,,,61.9,6.19,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.72,10.72,10.72,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,45.41,28.9,1068.67,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,28.9,28.9,28.9,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.72,10.72,10.72,19,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.04,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.05,448,,facility
CLOT FACTOR VIII VW ANTIGEN,85246,CPT,305,RC,,,,outpatient,,,172,17.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,20.4,20.4,20.4,44,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,23.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,71.28,45.36,71.28,1 through 10,percent of total billed charges,,,33.6,,45.36,45.36,45.36,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,45.77,45.36,45.77,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,47.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,24.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,67.5,67.5,67.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,20.4,20.4,20.4,74,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,24.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,49.56,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,23.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,22.94,448,,facility
URINE CULTURE/COLONY COUNT,87086,CPT,306,RC,,,,outpatient,,,30,3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,7.18,7.18,7.18,21,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,65.92,35.84,65.92,12,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,46.61,33.04,143.37,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,54.38,34.61,58.81,1 through 10,percent of total billed charges,,,33.6,,32.04,32.04,34.61,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,34.61,18.82,34.61,12,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,16.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,51.5,51.5,51.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,21.63,21.63,21.63,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,7.18,7.18,7.18,106,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.43,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,8.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,8.07,448,,facility
ASSAY OF PSA TOTAL,84153,CPT,301,RC,,,,outpatient,,,13,1.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.36,16.36,16.36,28,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,49.86,25.75,175.82,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,100.13,28.56,157.34,43,percent of total billed charges,,,33.6,,100.13,28.56,101.02,12,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,28.56,28.56,101.02,71,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,42.5,42.5,42.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,17.85,17.85,17.85,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.36,16.36,16.36,55,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,39.74,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.39,448,,facility
DRUG SCREENING TRAMADOL,80373,CPT,301,RC,,,,outpatient,,,35,3.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
NFCT AGT GNTYP ALYS HIV1,87906,CPT,306,RC,,,,outpatient,,,1405,140.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,120.95,120.95,120.95,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,128.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,128.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,132.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,108.24,108.24,108.24,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,128.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,269.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,136.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,114.5,114.5,114.5,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,128.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,136.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,278.11,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,131.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,128.73,448,,facility
DETECT AGENT NOS DNA AMP,87798,CPT,306,RC,,,,outpatient,,,58,5.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,110.88,110.88,174.24,1 through 10,percent of total billed charges,,,33.6,,244.27,244.27,244.27,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,96.77,32.38,119.79,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,38.9,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
DRUG TEST PRSMV CHEM ANLYZR,80307,CPT,301,RC,,,,outpatient,,,430,43,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,55.27,55.27,55.27,34,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,62.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,62.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,171.87,131.38,223.26,14,percent of total billed charges,,,33.6,,206.45,131.38,223.26,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,131.38,102.04,131.38,13,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,62.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,129.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,65.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,55.27,55.27,55.27,332,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,62.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,65.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,125.7,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,63.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,62.14,448,,facility
MOPATH PROCEDURE LEVEL 7,81406,CPT,310,RC,,,,outpatient,,,1875,187.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,282.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,282.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,291.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,282.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,591.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,299.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,282.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,299.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,495.04,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,288.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,282.88,591.22,,facility
ASSAY OF URINE PORPHYRINS,84120,CPT,301,RC,,,,outpatient,,,39.3,3.93,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,62.3,62.3,62.3,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,30.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,31.78,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.71,448,,facility
NUCLEAR ANTIGEN ANTIBODY,86235,CPT,302,RC,,,,outpatient,,,48,4.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13,12.5,15.95,11,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,54.91,4.37,90.29,43,percent of total billed charges,,,33.6,,4.37,4.37,53.09,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,22.18,4.24,83.33,13,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,37.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.95,13,15.95,54,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.75,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.93,448,,facility
WEST NILE VIRUS ANTIBODY,86789,CPT,302,RC,,,,outpatient,,,54.95,5.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,63.5,63.5,63.5,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,30.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.8,12.8,12.8,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,31.1,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.39,448,,facility
ASSAY OF PROSTAGLANDIN,84150,CPT,301,RC,,,,outpatient,,,410,41,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,41.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,41.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,43.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,41.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,87.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,44.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,41.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,44.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,73.1,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,42.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,41.77,448,,facility
ASSAY OF CARNITINE,82379,CPT,301,RC,,,,outpatient,,,62,6.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.01,15.01,15.01,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,191.14,191.14,191.14,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,35.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.01,15.01,15.01,15,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.45,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,16.87,448,,facility
ASSAY OF NOS VITAMIN,84591,CPT,301,RC,,,,outpatient,,,90,9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,35.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.86,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.06,448,,facility
N.GONORRHOEAE DNA AMP PROB,87591,CPT,306,RC,,,,outpatient,,,30.5,3.05,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,442,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,50.15,20.65,65.49,11,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,228.48,228.48,228.48,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,37.3,18.48,58.61,60,percent of total billed charges,,,33.6,,37.3,11.76,63.38,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,28.82,11.76,37.3,69,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,42.5,17.5,55.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,23.31,23.31,23.31,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,31.21,31.21,31.21,1 through 10,percent of total billed charges,,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,796,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
COAGULATION TIME ACTIVATED,85347,CPT,305,RC,,,,outpatient,,,18.75,1.88,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,57.12,38.17,224.4,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,8.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.81,3.81,3.81,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.21,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,4.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,4.28,448,,facility
ASSAY OF PROLACTIN,84146,CPT,301,RC,,,,outpatient,,,20,2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,17.24,17.24,17.24,56,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,43.66,43.66,43.66,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,39.07,24.86,139.92,20,percent of total billed charges,,,33.6,,89.04,89.04,139.92,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,24.86,24.86,89.04,15,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,40.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,20.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,36.75,36.75,37,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,15.54,15.54,15.54,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,17.24,17.24,17.24,96,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,20.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,41.86,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,19.38,448,,facility
HEPATITIS C REVRS TRNSCRPJ,87522,CPT,306,RC,,,,outpatient,,,180,18,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,38.11,38.11,38.11,12,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,44.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,101.14,101.14,101.14,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,101.14,101.14,101.14,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,89.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,45.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,38.11,38.11,38.11,29,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,45.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,92.54,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,43.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,42.84,448,,facility
MOPATH PROCEDURE LEVEL 6,81405,CPT,310,RC,,,,outpatient,,,1183,118.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,301.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,301.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,310.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,301.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,629.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,319.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,301.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,319.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,527.36,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,307.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,301.35,629.82,,facility
CMV ANTIBODY,86644,CPT,302,RC,,,,outpatient,,,37,3.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.8,12.8,12.8,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,30.08,30.08,85.12,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,70.22,44.69,76.56,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,49.24,48.72,49.24,1 through 10,percent of total billed charges,,,34.6,,48.28,17.91,50.67,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,30.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.8,12.8,12.8,11,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,31.1,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.39,448,,facility
ASSAY OF LEAD,83655,CPT,301,RC,,,,outpatient,,,24.1,2.41,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.77,10.77,10.77,70,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,47.79,47.79,47.79,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,27.22,27.22,42.77,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,11.76,11.76,27.22,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,40.5,40.5,40.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.77,10.77,10.77,84,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.16,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.11,448,,facility
MASS SPECTROMETRY QUAL/QUAN,83789,CPT,301,RC,,,,outpatient,,,274,27.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,24.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,50.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,25.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,24.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,25.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.19,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,24.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,24.11,448,,facility
QUANTITATIVE ASSAY DRUG,80299,CPT,301,RC,,,,outpatient,,,45,4.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,13,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,174.64,174.64,174.64,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,171.6,171.6,171.6,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,374.52,374.52,374.52,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.62,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.64,448,,facility
ASSAY OF LEAD,83655,CPT,301,RC,,,,outpatient,,,44,4.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.77,10.77,10.77,70,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,47.79,47.79,47.79,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,27.22,27.22,42.77,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,11.76,11.76,27.22,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,40.5,40.5,40.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.77,10.77,10.77,84,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.16,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.11,448,,facility
JOHN CUNNINGHAM ANTIBODY,86711,CPT,302,RC,,,,outpatient,,,35,3.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,105.02,105.02,105.02,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,35.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.02,15.02,15.02,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,31.1,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,16.89,448,,facility
ASSAY IGA/IGD/IGG/IGM EACH,82784,CPT,301,RC,,,,outpatient,,,40,4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,8.27,8.27,8.27,98,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,114.46,59,343.38,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,52.8,30.49,158.4,64,percent of total billed charges,,,33.6,,19.58,19.49,33.6,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,53.09,19.49,195.55,67,percent of total billed charges,,,34.6,,190.57,73.91,336.04,67,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,9.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,19.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,9.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,29,29,50,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,8.27,8.27,8.27,371,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,9.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,9.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.09,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,9.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,9.3,448,,facility
TOTAL CORTISOL,82533,CPT,301,RC,,,,outpatient,,,34,3.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,14.5,14.5,14.5,28,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,68.44,68.44,68.44,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,203.28,61.25,203.28,34,percent of total billed charges,,,33.6,,203.28,129.36,203.28,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,129.36,29.57,130.52,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,34.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,192.5,58,192.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,14.5,14.5,14.5,104,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.21,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,16.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,16.3,448,,facility
NUCLEAR ANTIGEN ANTIBODY,86235,CPT,302,RC,,,,outpatient,,,150,15,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13,12.5,15.95,11,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,54.91,4.37,90.29,43,percent of total billed charges,,,33.6,,4.37,4.37,53.09,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,22.18,4.24,83.33,13,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,37.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.95,13,15.95,54,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.75,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.93,448,,facility
B-12 BINDING CAPACITY,82608,CPT,301,RC,,,,outpatient,,,36.65,3.67,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,29.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.94,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.32,448,,facility
UNLISTED MOLECULAR PATHOLOGY,81479,CPT,310,RC,,,,outpatient,,,1319,131.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,561.56,561.56,561.56,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,32.5,32.5,3071.5,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
IMMUNODIFFUSION OUCHTERLONY,86331,CPT,302,RC,,,,outpatient,,,22,2.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.66,10.66,10.66,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.88,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.98,448,,facility
IMMUNOASSAY QUANT NOS NONAB,83520,CPT,301,RC,,,,outpatient,,,43.5,4.35,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,36,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,66.08,66.08,66.08,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,41.18,24.82,318.38,1 through 10,percent of total billed charges,,,33.6,,37.63,37.63,96.43,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,33.6,23.18,176.4,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,36.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,87,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.22,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.27,448,,facility
FLUORESCENT ANTIBODY SCREEN,86255,CPT,302,RC,,,,outpatient,,,80,8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.72,10.72,10.72,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,45.41,28.9,1068.67,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,28.9,28.9,28.9,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.72,10.72,10.72,19,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.04,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.05,448,,facility
COMPLEMENT/FUNCTION ACTIVITY,86161,CPT,302,RC,,,,outpatient,,,275,27.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.92,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12,448,,facility
RUBELLA ANTIBODY,86762,CPT,302,RC,,,,outpatient,,,10,1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.8,12.8,12.8,18,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,28.32,28.32,28.32,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,25.34,16.13,25.34,14,percent of total billed charges,,,33.6,,16.13,16.13,16.13,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,16.13,16.13,16.27,22,percent of total billed charges,,,34.6,,68.61,68.61,68.61,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,30.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,24,24,44.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,12.8,12.8,12.8,1 through 10,percent of total billed charges,,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.8,12.8,12.8,185,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,31.1,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.39,448,,facility
RUBELLA ANTIBODY,86762,CPT,302,RC,,,,outpatient,,,115,11.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.8,12.8,12.8,18,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,28.32,28.32,28.32,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,25.34,16.13,25.34,14,percent of total billed charges,,,33.6,,16.13,16.13,16.13,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,16.13,16.13,16.27,22,percent of total billed charges,,,34.6,,68.61,68.61,68.61,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,30.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,24,24,44.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,12.8,12.8,12.8,1 through 10,percent of total billed charges,,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.8,12.8,12.8,185,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,31.1,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.39,448,,facility
SYPHILIS TEST NON-TREP QUANT,86593,CPT,302,RC,,,,outpatient,,,5,0.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.91,3.91,3.91,33,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,30.56,30.56,30.72,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,30.72,30.72,30.72,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,25.34,25.34,49.68,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,9.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.91,3.91,3.91,34,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.52,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,4.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,4.4,448,,facility
UNLISTED MOLECULAR PATHOLOGY,81479,CPT,310,RC,,,,outpatient,,,25,2.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,561.56,561.56,561.56,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,32.5,32.5,3071.5,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
PROTOZOA ANTIBODY NOS,86753,CPT,302,RC,,,,outpatient,,,216,21.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.02,11.02,11.02,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,98.11,98.11,154.18,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,96.77,32.38,106,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.02,11.02,11.02,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.76,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.39,448,,facility
PMS2 GENE FULL SEQ ANALYSIS,81317,CPT,310,RC,,,,outpatient,,,421,42.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,676.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,676.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,696.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,676.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1413.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,717.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,676.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,717.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1237.29,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,690.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1413.88,,facility
ALPHA-FETOPROTEIN SERUM,82105,CPT,301,RC,,,,outpatient,,,25,2.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,14.92,14.92,14.92,44,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,215.35,215.35,215.35,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,58.61,58.61,192.72,11,percent of total billed charges,,,33.6,,58.61,37.3,122.64,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,37.3,37.3,123.74,15,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,35.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,14.92,14.92,14.92,104,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.24,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,16.77,448,,facility
HEAVY METAL QUAN EACH NES,83018,CPT,301,RC,,,,outpatient,,,61.25,6.13,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,21.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,45.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,23.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,21.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,23.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,47.46,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,22.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,21.96,448,,facility
VIRUS ANTIBODY NOS,86790,CPT,302,RC,,,,outpatient,,,45,4.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.46,11.46,11.46,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,107.86,20.06,169.49,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,116.52,40.29,122.3,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,26.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.46,11.46,11.46,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.88,448,,facility
M.TUBERCULO DNA AMP PROBE,87556,CPT,306,RC,,,,outpatient,,,150,15,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,41.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,41.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,41.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,87.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,44.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,41.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,44.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,42.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,41.68,448,,facility
PLATELET ANTIBODIES,86022,CPT,302,RC,,,,outpatient,,,307,30.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.34,16.34,16.34,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,39.69,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.37,448,,facility
IMMUNOASSAY QUANT NOS NONAB,83520,CPT,301,RC,,,,outpatient,,,181.5,18.15,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,36,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,66.08,66.08,66.08,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,41.18,24.82,318.38,1 through 10,percent of total billed charges,,,33.6,,37.63,37.63,96.43,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,33.6,23.18,176.4,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,36.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,87,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.22,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.27,448,,facility
RHEUMATOID FACTOR QUANT,86431,CPT,302,RC,,,,outpatient,,,72,7.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.04,5.04,5.04,26,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,33.63,33.63,33.63,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,30.1,19.05,30.1,1 through 10,percent of total billed charges,,,33.6,,19.15,19.15,30.1,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,19.15,19.15,19.24,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,11.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.04,5.04,5.04,75,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.25,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.67,448,,facility
ASSAY OF THYROID (T3 OR T4),84479,CPT,301,RC,,,,outpatient,,,18,1.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.75,5.75,5.75,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,70.56,27.98,119.91,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,17.97,17.81,70.56,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,13.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.75,5.75,5.75,23,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.97,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,6.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,6.47,448,,facility
CULTURE TYPE IMMUNOLOGIC,87147,CPT,306,RC,,,,outpatient,,,28.5,2.85,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.61,4.61,4.61,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,69.03,69.03,69.03,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,57.55,36.95,66.81,12,percent of total billed charges,,,33.6,,39.31,39.31,39.31,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,39.31,39.31,39.31,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,10.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,58.5,58.5,58.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.61,4.61,4.61,65,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.18,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.18,448,,facility
TRANSFERASE (AST) (SGOT),84450,CPT,301,RC,,,,outpatient,,,4,0.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.61,4.61,4.61,56,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,23.6,23.6,23.6,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,231.83,21.12,231.83,76,percent of total billed charges,,,33.6,,136.42,13.44,231.83,18,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,136.42,13.44,137.63,57,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,10.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,203,20,203,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,8.4,8.4,8.4,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.61,4.61,4.61,642,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.18,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.18,448,,facility
QUANTITATIVE ASSAY DRUG,80299,CPT,301,RC,,,,outpatient,,,75,7.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,13,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,174.64,174.64,174.64,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,171.6,171.6,171.6,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,374.52,374.52,374.52,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.62,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.64,448,,facility
IMMUNOASSAY QUANT NOS NONAB,83520,CPT,301,RC,,,,outpatient,,,129,12.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,36,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,66.08,66.08,66.08,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,41.18,24.82,318.38,1 through 10,percent of total billed charges,,,33.6,,37.63,37.63,96.43,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,33.6,23.18,176.4,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,36.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,87,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.22,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.27,448,,facility
ASSAY OF SIALIC ACID,84275,CPT,301,RC,,,,outpatient,,,38.3,3.83,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,28.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.03,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.44,448,,facility
DRUG SCREEN QUANTALCOHOLS,80320,CPT,301,RC,,,,outpatient,,,147,14.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
ANTINUCLEAR ANTIBODIES,86038,CPT,302,RC,,,,outpatient,,,72.5,7.25,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.75,10.75,10.75,34,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,148.09,148.09,148.09,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,84.34,29.04,132.53,14,percent of total billed charges,,,33.6,,84.34,18.48,127.78,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,84.34,84.34,85.09,12,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,11.55,11.55,11.55,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.75,10.75,10.75,126,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.11,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.09,448,,facility
TRICYCLIC & CYCLICALS 6/MORE,80337,CPT,301,RC,,,,outpatient,,,40,4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
FMR1 GEN ALY DETC ABNL ALLEL,81243,CPT,310,RC,,,,outpatient,,,72,7.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,57.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,57.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,58.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,57.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,119.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,60.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,50.74,50.74,50.74,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,57.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,60.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,99.82,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,58.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,57.04,448,,facility
ASSAY OF ALDOSTERONE,82088,CPT,301,RC,,,,outpatient,,,70.1,7.01,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,36.25,36.25,36.25,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,32.45,32.45,63.72,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,40.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,40.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,41.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,29.04,18.48,29.04,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,18.48,17.81,46.37,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,40.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,85.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,43.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,36.25,36.25,36.25,24,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,40.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,43.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,88.04,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,41.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,40.75,448,,facility
CULTR BACTERIA EXCEPT BLOOD,87075,CPT,306,RC,,,,outpatient,,,14,1.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,8.42,8.42,8.42,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,229.49,229.49,306.67,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,229.49,229.49,229.49,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,9.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,19.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,8.42,8.42,8.42,55,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,9.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.46,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,9.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,9.47,448,,facility
FETAL CHRMOML ANEUPLOIDY,81420,CPT,310,RC,,,,outpatient,,,1218,121.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,675.16,675.16,675.16,181,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,1288.32,668.25,1288.32,15,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,1187.67,1187.67,1477.36,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,759.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,759.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,781.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,1062.86,676.37,1062.86,1 through 10,percent of total billed charges,,,33.6,,675.16,675.16,676.37,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,676.37,484.18,682.41,19,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,759.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1586.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,804.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,1006.5,1006.5,1006.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,593.47,593.47,593.47,1 through 10,percent of total billed charges,,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,675.16,675.16,675.16,133,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,759.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,804.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1328.34,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,774.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1586.41,,facility
ASSAY OF DIGOXIN TOTAL,80162,CPT,301,RC,,,,outpatient,,,14,1.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.68,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.28,448,,facility
CYTOG ALYS CHRML ABNR SNPCGH,81229,CPT,310,RC,,,,outpatient,,,1455,145.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,1031.8,1031.8,1031.8,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1160,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1160,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1194.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,1457.28,1457.28,1457.28,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,2671.54,2671.54,2671.54,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1160,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,2424.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1229.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,1031.8,1031.8,1031.8,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1160,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1229.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2030,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1183.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,2424.4,,facility
SCREENING TEST FOR AUTOIMMUNE DISORDER,86038,CPT,0302,RC,,,,outpatient,,,40,4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.75,10.75,10.75,34,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,148.09,148.09,148.09,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,84.34,29.04,132.53,14,percent of total billed charges,,,33.6,,84.34,18.48,127.78,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,84.34,84.34,85.09,12,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,11.55,11.55,11.55,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.75,10.75,10.75,126,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.11,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.09,448,,facility
ANCA SCREEN EACH ANTIBODY,86036,CPT,302,RC,,,,outpatient,,,139,13.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.09,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.05,448,,facility
ASSAY OF TSI GLOBULIN,84445,CPT,301,RC,,,,outpatient,,,75.45,7.55,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,45.24,45.24,45.24,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,342.79,342.79,342.79,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,50.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,50.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,52.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,73.39,46.7,306.77,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,46.95,46.95,195.22,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,50.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,106.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,53.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,45.24,45.24,45.24,18,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,50.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,53.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,109.87,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,51.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,50.86,448,,facility
NUCLEAR ANTIGEN ANTIBODY,86235,CPT,302,RC,,,,outpatient,,,183,18.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13,12.5,15.95,11,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,54.91,4.37,90.29,43,percent of total billed charges,,,33.6,,4.37,4.37,53.09,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,22.18,4.24,83.33,13,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,37.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.95,13,15.95,54,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.75,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.93,448,,facility
AMINO ACIDS SINGLE QUANT,82131,CPT,301,RC,,,,outpatient,,,26.5,2.65,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,23.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,48.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,24.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,24.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,40.22,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,23.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,22.98,448,,facility
ASPERGILLUS ANTIBODY,86606,CPT,302,RC,,,,outpatient,,,18.17,1.82,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,31.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.39,13.39,13.39,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.53,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,15.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,15.05,448,,facility
ALLG SPEC IGE CRUDE XTRC EA,86003,CPT,302,RC,,,,outpatient,,,5,0.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.64,4.64,4.64,14,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,77.88,77.88,77.88,12,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,110.88,18.14,178.46,68,percent of total billed charges,,,33.6,,110.88,110.88,110.88,30,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,110.88,44.35,161.62,185,percent of total billed charges,,,34.6,,125.73,125.73,125.73,30,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,10.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.64,4.64,4.64,26,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.27,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.22,448,,facility
ASSAY OF URINE CREATININE,82570,CPT,301,RC,,,,outpatient,,,33,3.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.61,4.61,4.61,213,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,71.39,41.89,142.78,14,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,37.49,23.86,74.98,60,percent of total billed charges,,,33.6,,37.49,23.85,81.31,18,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,24.07,23.86,47.71,75,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,10.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,60.5,4.61,151,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,14.91,14.91,25.41,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,85.58,85.58,85.58,1 through 10,percent of total billed charges,,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.61,4.61,4.61,636,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.18,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.18,448,,facility
ASSAY OF CYANIDE,82600,CPT,301,RC,,,,outpatient,,,84,8.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,40.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,20.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,20.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,41.91,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,19.4,448,,facility
MSH6 GENE DUP/DELETE VARIANT,81300,CPT,310,RC,,,,outpatient,,,164,16.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,238,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,238,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,245.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,238,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,497.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,252.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,238,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,252.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,416.5,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,242.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,238,497.42,,facility
VIRUS ANTIBODY NOS,86790,CPT,302,RC,,,,outpatient,,,107.55,10.76,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.46,11.46,11.46,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,107.86,20.06,169.49,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,116.52,40.29,122.3,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,26.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.46,11.46,11.46,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.88,448,,facility
SO NEO GSAP 5-50DNA/DNA&RNA,81445,CPT,310,RC,,,,outpatient,,,3000,300,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,597.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,597.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,615.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,597.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1249.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,633.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,597.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,633.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1046.34,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,609.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1249.63,,facility
IMMUNOASSAY QUANT NOS NONAB,83520,CPT,301,RC,,,,outpatient,,,370,37,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,36,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,66.08,66.08,66.08,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,41.18,24.82,318.38,1 through 10,percent of total billed charges,,,33.6,,37.63,37.63,96.43,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,33.6,23.18,176.4,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,36.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,87,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.22,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.27,448,,facility
IMMUNFIX E-PHORSIS/URINE/CSF,86335,CPT,302,RC,,,,outpatient,,,14.4,1.44,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,26.11,26.11,26.11,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,25.76,25.76,25.76,1 through 10,percent of total billed charges,,,34.6,,56.99,56.99,56.99,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,29.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,61.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,31.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,26.11,26.11,26.11,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,29.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,31.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,63.4,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,29.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,29.35,448,,facility
INHIBIN A,86336,CPT,302,RC,,,,outpatient,,,47,4.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.87,13.87,13.87,11,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,102.48,102.48,102.48,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,12.1,12.1,25.54,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,32.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.87,13.87,13.87,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,33.67,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,15.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,15.59,448,,facility
HEPATITIS A ANTIBODY,86708,CPT,302,RC,,,,outpatient,,,16,1.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.02,11.02,11.02,30,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,76.16,76.16,76.16,24,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,70.21,70.21,70.21,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,62.83,39.98,62.83,12,percent of total billed charges,,,33.6,,39.98,39.98,62.83,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,39.98,39.98,201.6,23,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,59.5,59.5,59.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.02,11.02,11.02,102,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.76,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.39,448,,facility
HELMINTH ANTIBODY,86682,CPT,302,RC,,,,outpatient,,,62.9,6.29,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.57,11.57,11.57,36,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,56.78,56.78,66.44,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.57,11.57,11.57,12,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.11,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.01,448,,facility
ASSAY OF CITRATE,82507,CPT,301,RC,,,,outpatient,,,80.25,8.03,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,27.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,58.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,29.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,27.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,29.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,60.08,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,28.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,27.8,448,,facility
AMINO ACIDS SINGLE QUANT,82131,CPT,301,RC,,,,outpatient,,,146,14.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,23.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,48.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,24.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,24.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,40.22,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,23.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,22.98,448,,facility
ASSAY OF HALOPERIDOL,80173,CPT,301,RC,,,,outpatient,,,44.8,4.48,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,32.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,31.47,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,16.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,15.78,448,,facility
EPSTEIN-BARR NUCLEAR ANTIGEN,86664,CPT,302,RC,,,,outpatient,,,41,4.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.6,13.6,13.6,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,49.92,22.4,49.92,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,41.18,41.18,41.18,1 through 10,percent of total billed charges,,,33.6,,71.57,71.57,71.57,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,28.56,28.56,71.57,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,31.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.6,13.6,13.6,15,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,33.04,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,15.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,15.29,448,,facility
HEMOGLOBIN ELECTROPHORESIS,83020,CPT,301,RC,,,,outpatient,,,69,6.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.45,11.45,11.45,22,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,12.1,12.1,12.29,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,26.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,18,18,18,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,29.19,29.19,29.19,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.45,11.45,11.45,47,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.81,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.87,448,,facility
DNA/RNA SEQUENCING,87153,CPT,306,RC,,,,outpatient,,,571,57.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,102.61,102.61,102.61,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,115.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,115.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,118.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,385.39,385.39,385.39,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,115.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,241.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,122.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,115.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,122.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,249.24,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,117.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,115.36,448,,facility
ASSAY ALKALINE PHOSPHATASE,84075,CPT,301,RC,,,,outpatient,,,8,0.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.61,4.61,4.61,50,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,15.34,10.36,15.34,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,81,81,81,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,46.25,13.73,46.25,76,percent of total billed charges,,,33.6,,27.22,8.74,46.25,18,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,27.22,8.74,27.46,55,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,10.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,40.5,13,40.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,5.46,5.46,5.46,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.61,4.61,4.61,627,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.18,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.18,448,,facility
UNLISTED MOLECULAR PATHOLOGY,81479,CPT,310,RC,,,,outpatient,,,1295,129.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,561.56,561.56,561.56,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,32.5,32.5,3071.5,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
TRICYCLIC & CYCLICALS 6/MORE,80337,CPT,301,RC,,,,outpatient,,,35,3.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
ROTAVIRUS AG IA,87425,CPT,306,RC,,,,outpatient,,,30,3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.9,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.98,448,,facility
FUNGI IDENTIFICATION YEAST,87106,CPT,306,RC,,,,outpatient,,,45,4.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,21.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9.18,9.18,9.18,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.3,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,10.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,10.32,448,,facility
ASSAY OF URINE PHOSPHORUS,84105,CPT,301,RC,,,,outpatient,,,45,4.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.14,5.14,5.14,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,12.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.18,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.78,448,,facility
GARDNER VAG DNA DIR PROBE,87510,CPT,306,RC,,,,outpatient,,,91,9.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,20.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,41.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,21.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,20.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,21.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,43.33,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,20.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,20.05,448,,facility
B CELLS TOTAL COUNT,86355,CPT,302,RC,,,,outpatient,,,39.5,3.95,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,33.56,33.56,33.56,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,60.77,60.77,60.77,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,37.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,37.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,27.98,27.98,27.98,1 through 10,percent of total billed charges,,,33.6,,33.56,33.56,33.56,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,63.63,63.63,63.63,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,78.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,39.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,33.56,33.56,33.56,25,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,39.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,81.52,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,38.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,37.73,448,,facility
ASSAY OF SEX HORMONE GLOBUL,84270,CPT,301,RC,,,,outpatient,,,89,8.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.33,19.33,19.33,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,168.43,168.43,182.15,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,108.14,107.18,108.14,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,21.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,45.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,23.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.33,19.33,19.33,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,21.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,23.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,46.95,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,22.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,21.73,448,,facility
METHYLPHENIDATE,80360,CPT,301,RC,,,,outpatient,,,135,13.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
DNA ANTIBODY NATIVE,86225,CPT,302,RC,,,,outpatient,,,128,12.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.22,12.22,12.22,16,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,32.21,29.57,46.46,11,percent of total billed charges,,,33.6,,29.57,29.57,29.57,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,29.66,29.57,98.11,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,28.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.22,12.22,12.22,49,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.7,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.74,448,,facility
ALKALOIDS NOS,80323,CPT,301,RC,,,,outpatient,,,47.8,4.78,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
UNLISTED CHEMISTRY PROCEDURE,84999,CPT,301,RC,,,,outpatient,,,22,2.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
ASSAY OF PROTEIN URINE,84156,CPT,301,RC,,,,outpatient,,,13,1.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.26,3.26,3.26,171,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,50.15,50.15,50.15,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,14.78,14.65,44.88,32,percent of total billed charges,,,33.6,,14.78,9.41,28.56,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,9.41,9.41,28.56,36,percent of total billed charges,,,34.6,,30.85,30.85,32.38,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,7.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,13.88,3.26,42.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.26,3.26,3.26,535,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.93,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,3.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,3.67,448,,facility
HETEROPHILE ANTIBODY SCREEN,86308,CPT,302,RC,,,,outpatient,,,16,1.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.61,4.61,4.61,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,138.77,138.77,224.4,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,133.23,133.23,133.23,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,10.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.61,4.61,4.61,39,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.18,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.18,448,,facility
ASSAY OF CITRATE,82507,CPT,301,RC,,,,outpatient,,,171,17.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,27.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,58.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,29.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,27.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,29.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,60.08,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,28.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,27.8,448,,facility
F2 GENE,81240,CPT,310,RC,,,,outpatient,,,210,21,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,58.43,58.43,58.43,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,65.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,65.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,67.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,137.28,137.28,137.28,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,219.41,219.41,219.41,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,65.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,137.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,69.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,58.43,58.43,58.43,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,65.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,69.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,114.96,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,65.69,448,,facility
EXOME SEQUENCE ANALYSIS,81416,CPT,310,RC,,,,outpatient,,,2202,220.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12000,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12000,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12360,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12000,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25080,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12720,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12000,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12720,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21000,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12240,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,25080,,facility
PROTEIN E-PHORESIS/URINE/CSF,84166,CPT,301,RC,,,,outpatient,,,38,3.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.86,15.86,15.86,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,21.5,21.5,21.5,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,21.58,21.58,21.58,1 through 10,percent of total billed charges,,,34.6,,87.63,87.63,89.3,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,37.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.86,15.86,15.86,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.52,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.83,448,,facility
ANTIPSYCHOTICS NOS 7/MORE,80344,CPT,301,RC,,,,outpatient,,,40,4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
ASSAY OF PROTEIN SERUM,84155,CPT,301,RC,,,,outpatient,,,4,0.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.26,3.26,3.26,55,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,23.6,23.6,23.6,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,316,316,316,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,180.44,21.12,180.44,76,percent of total billed charges,,,33.6,,106.18,13.44,180.44,18,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,106.18,13.44,107.12,57,percent of total billed charges,,,34.6,,120.4,120.4,120.4,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,7.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,158,20,158,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,8.4,8.4,8.4,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.26,3.26,3.26,650,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.93,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,3.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,3.67,448,,facility
MOPATH PROCEDURE LEVEL 5,81404,CPT,310,RC,,,,outpatient,,,151,15.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,274.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,274.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,283.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,274.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,574.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,291.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,274.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,291.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,480.95,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,280.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,274.83,574.39,,facility
LYME DISEASE ANTIBODY,86618,CPT,302,RC,,,,outpatient,,,223,22.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,35.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.15,15.15,15.15,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.79,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.03,448,,facility
ANDROSTANEDIOL GLUCURONIDE,82154,CPT,301,RC,,,,outpatient,,,84.3,8.43,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,28.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,60.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,30.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,28.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,30.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,62.3,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,29.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,28.83,448,,facility
PLASMA 1 DONOR FRZ W/IN 8 HR,P9017,HCPCS,390,RC,,,,outpatient,,,53.75,5.38,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,85.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,85.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,88.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,830.02,830.02,830.02,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,85.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,178.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,90.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,85.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,90.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,107,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,87.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,85.56,448,,facility
COL CHROMOTOGRAPHY QUAL/QUAN,82542,CPT,301,RC,,,,outpatient,,,241,24.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,21.43,21.43,21.43,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,435.07,435.07,435.07,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,24.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,50.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,25.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,21.43,21.43,21.43,15,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,24.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,25.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.16,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,24.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,24.09,448,,facility
THROMBIN TIME PLASMA,85670,CPT,305,RC,,,,outpatient,,,56,5.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,12.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.46,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.77,448,,facility
ANTITHROMBIN III ACTIVITY,85300,CPT,305,RC,,,,outpatient,,,47.5,4.75,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.54,10.54,10.54,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,38.54,24.53,38.54,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,24.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.54,10.54,10.54,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.6,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.85,448,,facility
DRUG SCREENING BUPRENORPHINE,80348,CPT,301,RC,,,,outpatient,,,35,3.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
IMMUNOASSAY QUANT NOS NONAB,83520,CPT,301,RC,,,,outpatient,,,120.9,12.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,36,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,66.08,66.08,66.08,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,41.18,24.82,318.38,1 through 10,percent of total billed charges,,,33.6,,37.63,37.63,96.43,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,33.6,23.18,176.4,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,36.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,87,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.22,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.27,448,,facility
ASSAY DIPROPYLACETIC ACD TOT,80164,CPT,301,RC,,,,outpatient,,,20,2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.04,12.04,12.04,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,47.04,47.04,47.04,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,28.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.04,12.04,12.04,12,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.26,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.54,448,,facility
CHORIONIC GONADOTROPIN TEST,84702,CPT,301,RC,,,,outpatient,,,6.5,0.65,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.39,13.39,13.39,99,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,35.99,35.99,146.32,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,32.21,32.21,141.61,16,percent of total billed charges,,,33.6,,32.21,20.5,83.33,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,20.5,20.5,83.33,45,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,31.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,12.81,12.81,12.81,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,13.39,13.39,13.39,1 through 10,percent of total billed charges,,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.39,13.39,13.39,208,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.53,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,15.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,15.05,448,,facility
TISSUE CULTURE SKIN/BIOPSY,88233,CPT,311,RC,,,,outpatient,,,350,35,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,125.18,125.18,125.18,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,140.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,140.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,144.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,140.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,294.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,149.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,140.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,149.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,304.05,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,143.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,140.73,448,,facility
CLOT FACTOR VIII AHG 1 STAGE,85240,CPT,305,RC,,,,outpatient,,,40,4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.92,15.92,15.92,48,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,98.21,62.5,349.44,1 through 10,percent of total billed charges,,,33.6,,62.5,62.5,62.5,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,62.88,62.5,62.88,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,37.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,93,92.75,93,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.92,15.92,15.92,80,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.68,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.9,448,,facility
RUSSELL VIPER VENOM DILUTED,85613,CPT,305,RC,,,,outpatient,,,25,2.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,8.52,8.52,8.52,20,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,82.37,20.06,82.37,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,52.42,52.42,52.42,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,9.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,20.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,8.52,8.52,8.52,34,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,9.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.7,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,9.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,9.58,448,,facility
TRICHOMONAS VAGINALIS AMPLIF,87661,CPT,306,RC,,,,outpatient,,,61.65,6.17,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,57,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,127.44,127.44,127.44,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,114.05,72.58,123.34,1 through 10,percent of total billed charges,,,33.6,,28.9,28.9,114.05,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,72.58,28.9,73.22,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,91,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
COLLAGEN CROSSLINKS,82523,CPT,301,RC,,,,outpatient,,,226.1,22.61,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,39.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.62,16.62,16.62,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,40.37,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.68,448,,facility
ASSAY OF ESTRIOL,82677,CPT,301,RC,,,,outpatient,,,16.25,1.63,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,21.51,21.51,21.51,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,7.73,7.73,7.73,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,24.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,50.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,25.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,21.51,21.51,51.51,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,24.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,25.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,52.24,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,24.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,24.18,448,,facility
JAK2 GENE TRGT SEQUENCE ALYS,81279,CPT,310,RC,,,,outpatient,,,250,25,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,185.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,185.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,190.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,185.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,387.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,196.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,164.73,164.73,164.73,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,185.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,196.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,324.1,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,188.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,185.2,448,,facility
CREATINE MB FRACTION,82553,CPT,301,RC,,,,outpatient,,,4,0.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.27,10.27,10.27,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,24.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.96,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,11.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.55,448,,facility
ASSAY OF UREA NITROGEN,84520,CPT,301,RC,,,,outpatient,,,4,0.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.51,3.51,3.51,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,7.9,7.9,7.9,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,37.69,22.18,37.69,1 through 10,percent of total billed charges,,,33.6,,22.18,22.18,22.18,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,22.18,19.49,43.73,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,8.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.51,3.51,3.51,46,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.54,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,4.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,3.95,448,,facility
LIPOPROTEIN BLD QUAN PART,83704,CPT,301,RC,,,,outpatient,,,48,4.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,34.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,34.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,34.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,71.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,36.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,34.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,36.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,68.16,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,34.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,34.19,448,,facility
CHIMERISM ANAL W/CELL SELECT,81268,CPT,310,RC,,,,outpatient,,,225,22.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,231.97,231.97,231.97,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,2152.96,2152.96,2152.96,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,260.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,260.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,268.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,653.4,653.4,685.8,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,1130.3,495.96,1221.13,22,percent of total billed charges,,,34.6,,1221.13,1221.13,2354.8,12,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,260.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,545.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,276.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,231.97,231.97,231.97,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,260.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,276.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,563.43,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,266.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,260.79,563.43,,facility
GLUCOSE OTHER FLUID,82945,CPT,301,RC,,,,outpatient,,,4.5,0.45,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,193.28,193.28,193.28,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,135.6,101.47,159.46,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,8.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,63.42,63.42,63.42,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.5,3.5,3.5,14,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.49,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,4.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,3.93,448,,facility
ANGIOTENSIN I ENZYME TEST,82164,CPT,301,RC,,,,outpatient,,,62,6.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.99,12.99,12.99,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,42.67,12.77,67.06,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,42.88,42.88,42.88,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,30.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.99,12.99,12.99,26,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,31.55,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.6,448,,facility
ASSAY OF CERULOPLASMIN,82390,CPT,301,RC,,,,outpatient,,,27.7,2.77,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9.55,9.55,9.55,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,21.65,21.65,21.65,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,13.78,13.78,13.9,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,22.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9.55,9.55,9.55,44,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,23.21,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,10.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,10.74,448,,facility
HEMOGLOBIN UNSTABLE SCREEN,83068,CPT,301,RC,,,,outpatient,,,62,6.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,9.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,19.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,9.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.29,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,9.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,9.47,448,,facility
ASSAY OF URINE OSMOLALITY,83935,CPT,301,RC,,,,outpatient,,,17,1.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,6.07,6.07,6.07,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,62.3,62.3,62.3,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,39.65,39.65,39.65,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,14.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,7.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,17,17,17,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,6.07,6.07,6.07,11,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,7.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.74,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,6.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,6.82,448,,facility
WEST NILE VIRUS AB IGM,86788,CPT,302,RC,,,,outpatient,,,37.5,3.75,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,63.5,63.5,63.5,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,35.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,14.99,14.99,14.99,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.4,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,16.85,448,,facility
IMFLUOR EA ADDL 1ANTB STN PX,88350,CPT,310,RC,,,,outpatient,,,19,1.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,26.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,55.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,28.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,26.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,28.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,76.23,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,27.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,26.49,448,,facility
CHLAMYDIA IGM ANTIBODY,86632,CPT,302,RC,,,,outpatient,,,18,1.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,26.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.41,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.68,448,,facility
LYME DISEASE ANTIBODY,86618,CPT,302,RC,,,,outpatient,,,129,12.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,35.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.15,15.15,15.15,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.79,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.03,448,,facility
MSH2 GENE FULL SEQ,81295,CPT,310,RC,,,,outpatient,,,248,24.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,381.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,381.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,393.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,381.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,797.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,404.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,381.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,404.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,667.98,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,389.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,381.7,797.75,,facility
CLOT INHIBIT PROT S FREE,85306,CPT,305,RC,,,,outpatient,,,27.5,2.75,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.63,13.63,13.63,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,29.04,18.48,29.04,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,81.65,81.65,81.65,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,32.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.63,13.63,13.63,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,33.11,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,15.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,15.32,448,,facility
URINE BACTERIA CULTURE,87088,CPT,306,RC,,,,outpatient,,,10,1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,7.2,7.2,7.2,305,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,314.24,56.32,314.24,57,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,51.92,51.92,289.69,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,259.25,46.46,280.36,74,percent of total billed charges,,,33.6,,164.98,152.74,280.36,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,164.98,29.57,166.45,56,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,16.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,245.5,44.13,245.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,18.53,18.53,103.11,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,7.2,7.2,10.02,1 through 10,percent of total billed charges,,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,7.2,7.2,7.2,951,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.48,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,8.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,8.09,448,,facility
NOS EACH ORGANISM AG IA,87449,CPT,306,RC,,,,outpatient,,,48,4.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,198,198,198,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,26.27,26.27,26.27,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.66,10.66,10.66,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.9,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.98,448,,facility
CLOT FACTOR VIII AHG 1 STAGE,85240,CPT,305,RC,,,,outpatient,,,172,17.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.92,15.92,15.92,48,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,98.21,62.5,349.44,1 through 10,percent of total billed charges,,,33.6,,62.5,62.5,62.5,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,62.88,62.5,62.88,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,37.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,93,92.75,93,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.92,15.92,15.92,80,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.68,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.9,448,,facility
ASSAY OF TOTAL ESTRADIOL,82670,CPT,301,RC,,,,outpatient,,,56,5.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,24.85,24.85,24.85,51,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,47.79,39.12,263.73,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,42.77,42.77,42.77,15,percent of total billed charges,,,33.6,,42.77,27.46,236.02,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,27.46,27.22,150.19,27,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,27.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,58.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,29.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,40.5,40.5,40.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,17.01,17.01,17.01,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,24.85,24.85,24.85,85,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,27.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,29.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,60.36,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,28.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,27.94,448,,facility
BLOOD VISCOSITY EXAMINATION,85810,CPT,305,RC,,,,outpatient,,,37.7,3.77,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,24.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.22,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,11.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.67,448,,facility
ENZYME CELL ACTIVITY,82657,CPT,301,RC,,,,outpatient,,,285,28.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.72,19.72,19.72,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,2094.14,2094.14,2094.14,1 through 10,percent of total billed charges,,,33.6,,762.96,762.96,762.96,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,46.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,23.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.72,19.72,19.72,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,23.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,39.01,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,22.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,22.17,448,,facility
HIV-2 PROBE&REVRSE TRNSCRIPJ,87538,CPT,306,RC,,,,outpatient,,,64,6.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,122.13,122.13,122.13,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
ASSAY OF CSF PROTEIN,83873,CPT,301,RC,,,,outpatient,,,37,3.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,35.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.3,15.3,15.3,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,37.17,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.2,448,,facility
RBC SED RATE AUTOMATED,85652,CPT,305,RC,,,,outpatient,,,3,0.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,2.4,2.4,2.4,155,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,12.8,12.8,12.8,42,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,11.8,11.8,11.8,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,10.56,6.72,147.32,64,percent of total billed charges,,,33.6,,10.56,6.72,86.69,12,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,6.78,6.72,86.69,51,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,5.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,10,10,129,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,4.2,4.2,4.2,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,2.4,2.4,2.4,674,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,2.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,2.7,448,,facility
TISSUE EXAM FOR FUNGI,87220,CPT,306,RC,,,,outpatient,,,8,0.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.8,3.8,3.8,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,8.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.8,3.8,3.8,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.22,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,4.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,4.27,448,,facility
ASSAY FOR PHENCYCLIDINE,83992,CPT,301,RC,,,,outpatient,,,35,3.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.6,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,75.6,448,,facility
ANTITHROMBIN III ANTIGEN,85301,CPT,305,RC,,,,outpatient,,,52,5.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9.62,9.62,9.62,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,95.09,95.09,95.09,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,22.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9.62,9.62,9.62,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,23.36,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,11.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,10.81,448,,facility
BABESIA MICROTI AMP PRB,87469,CPT,306,RC,,,,outpatient,,,465,46.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,61.41,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
DNA ANTIBODY NATIVE,86225,CPT,302,RC,,,,outpatient,,,150,15,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.22,12.22,12.22,16,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,32.21,29.57,46.46,11,percent of total billed charges,,,33.6,,29.57,29.57,29.57,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,29.66,29.57,98.11,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,28.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.22,12.22,12.22,49,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.7,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.74,448,,facility
THROMBOPLASTIN TIME PARTIAL,85732,CPT,305,RC,,,,outpatient,,,64,6.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.75,5.75,5.75,18,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,24.29,15.46,83.95,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,15.46,15.46,15.46,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,13.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.75,5.75,5.75,33,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.97,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,6.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,6.47,448,,facility
DETECT AGENT NOS DNA AMP,87798,CPT,306,RC,,,,outpatient,,,148.5,14.85,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,110.88,110.88,174.24,1 through 10,percent of total billed charges,,,33.6,,244.27,244.27,244.27,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,96.77,32.38,119.79,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,38.9,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
HEPATIC FUNCTION PANEL,80076,CPT,301,RC,,,,outpatient,,,6,0.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,17.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.66,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,8.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,8.17,448,,facility
IMMUNOASSAY QUANT NOS NONAB,83520,CPT,301,RC,,,,outpatient,,,225,22.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,36,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,66.08,66.08,66.08,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,41.18,24.82,318.38,1 through 10,percent of total billed charges,,,33.6,,37.63,37.63,96.43,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,33.6,23.18,176.4,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,36.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,87,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.22,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.27,448,,facility
ASSAY OF FOLIC ACID SERUM,82746,CPT,301,RC,,,,outpatient,,,16,1.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.08,13.08,13.08,44,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,67.11,67.11,227.15,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,60.19,60.19,203.28,1 through 10,percent of total billed charges,,,33.6,,38.56,38.3,129.36,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,38.3,38.3,38.3,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,30.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,57,57,57,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,80.85,80.85,80.85,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.08,13.08,13.08,116,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,31.76,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.7,448,,facility
NUCLEAR ANTIGEN ANTIBODY,86235,CPT,302,RC,,,,outpatient,,,10.5,1.05,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13,12.5,15.95,11,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,54.91,4.37,90.29,43,percent of total billed charges,,,33.6,,4.37,4.37,53.09,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,22.18,4.24,83.33,13,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,37.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.95,13,15.95,54,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.75,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.93,448,,facility
FUNGI IDENTIFICATION MOLD,87107,CPT,306,RC,,,,outpatient,,,45,4.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,70.56,70.56,70.56,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,70.56,70.56,70.56,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,21.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9.18,9.18,9.18,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.3,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,10.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,10.32,448,,facility
HBA1/HBA2 GENE,81257,CPT,310,RC,,,,outpatient,,,360.1,36.01,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,102.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,102.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,105.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,102.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,213.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,108.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,102.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,108.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,178.96,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,104.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,102.26,448,,facility
EXOME SEQUENCE ANALYSIS,81416,CPT,310,RC,,,,outpatient,,,2108,210.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12000,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12000,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12360,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12000,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25080,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12720,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12000,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12720,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21000,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12240,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,25080,,facility
RICKETTSIA ANTIBODY,86757,CPT,302,RC,,,,outpatient,,,120.75,12.08,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,17.21,17.21,17.21,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,40.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,20.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,17.21,17.21,17.21,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,20.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,41.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,19.35,448,,facility
BASIC METABLC PNL IONIZED CA,80047,CPT,301,RC,,,,outpatient,,,60,6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.21,12.21,12.21,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,49.17,49.17,49.17,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,147.89,87.02,147.89,104,percent of total billed charges,,,33.6,,87.02,87.02,147.89,17,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,87.02,87.02,87.8,37,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,28.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,129.5,129.5,129.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,259,259,259,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.21,12.21,12.21,543,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.03,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.73,448,,facility
IG LIGHT CHAINS FREE EACH,83521,CPT,301,RC,,,,outpatient,,,187,18.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,52.42,52.42,52.42,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,36.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,16,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.22,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.27,448,,facility
ASSAY OF URINE PHOSPHORUS,84105,CPT,301,RC,,,,outpatient,,,38,3.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.14,5.14,5.14,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,12.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.18,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.78,448,,facility
DRUG SCREENING TRAMADOL,80373,CPT,301,RC,,,,outpatient,,,40,4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
IMMUNOASSAY NONANTIBODY,83516,CPT,301,RC,,,,outpatient,,,44,4.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9,9,10.26,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,4.75,4.75,218.59,30,percent of total billed charges,,,33.6,,3.02,3.02,175.39,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,3.02,3.02,211.68,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,24.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,23.5,23.5,23.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9,9,10.26,51,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.92,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,11.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.53,448,,facility
DRUG SCREENING PROPOXYPHENE,80367,CPT,301,RC,,,,outpatient,,,35,3.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
STIMULANTS SYNTHETIC,80371,CPT,301,RC,,,,outpatient,,,35,3.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
IMMUNOASSAY NONANTIBODY,83516,CPT,301,RC,,,,outpatient,,,131,13.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9,9,10.26,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,4.75,4.75,218.59,30,percent of total billed charges,,,33.6,,3.02,3.02,175.39,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,3.02,3.02,211.68,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,24.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,23.5,23.5,23.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9,9,10.26,51,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.92,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,11.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.53,448,,facility
NFCT AGT GNTYP ALYS HIV1 REV,87901,CPT,306,RC,,,,outpatient,,,391,39.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,295,295,295,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,257.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,257.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,265.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,264,264,264,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,257.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,538.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,272.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,229,229,229,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,257.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,272.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,556.22,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,262.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,257.45,556.22,,facility
DRUG ASSAY EVEROLIMUS,80169,CPT,301,RC,,,,outpatient,,,274.15,27.42,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.21,12.21,12.21,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,339.36,339.36,339.36,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,313.24,313.24,313.24,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,28.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.21,12.21,12.21,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.68,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.73,448,,facility
ASSAY OF ADP & AMP,82030,CPT,301,RC,,,,outpatient,,,56,5.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,25.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,53.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,27.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,25.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,27.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,55.74,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,26.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,25.8,448,,facility
ALPHA-1-ANTITRYPSIN TOTAL,82103,CPT,301,RC,,,,outpatient,,,37.55,3.76,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.95,11.95,11.95,14,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,15.79,11.42,30.1,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,19.15,11.42,48.05,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,28.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.95,11.95,11.95,58,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.03,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.44,448,,facility
COMPLEMENT ANTIGEN,86160,CPT,302,RC,,,,outpatient,,,431,43.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.67,10.67,10.67,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,87.32,87.32,87.32,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,78.14,49.73,270.86,17,percent of total billed charges,,,33.6,,49.73,49.73,172.37,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,49.73,29.23,50.32,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,256.5,256.5,256.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.67,10.67,10.67,61,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.92,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12,448,,facility
ASSAY OF VANCOMYCIN,80202,CPT,301,RC,,,,outpatient,,,18,1.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,28.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.04,12.04,12.04,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.26,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.54,448,,facility
WHOLE MITOCHONDRIAL GENOME,81460,CPT,310,RC,,,,outpatient,,,775,77.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1287,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1287,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1325.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1287,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,2689.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1364.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1287,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1364.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2252.25,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1312.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,2689.83,,facility
DRUG SCREENING FENTANYL,80354,CPT,301,RC,,,,outpatient,,,40,4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
DRUG TEST PRSMV CHEM ANLYZR,80307,CPT,301,RC,,,,outpatient,,,132,13.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,55.27,55.27,55.27,34,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,62.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,62.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,171.87,131.38,223.26,14,percent of total billed charges,,,33.6,,206.45,131.38,223.26,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,131.38,102.04,131.38,13,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,62.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,129.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,65.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,55.27,55.27,55.27,332,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,62.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,65.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,125.7,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,63.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,62.14,448,,facility
WEST NILE VIRUS ANTIBODY,86789,CPT,302,RC,,,,outpatient,,,37.5,3.75,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,63.5,63.5,63.5,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,30.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.8,12.8,12.8,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,31.1,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.39,448,,facility
M.TUBERCULO DNA AMP PROBE,87556,CPT,306,RC,,,,outpatient,,,277.65,27.77,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,41.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,41.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,41.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,87.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,44.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,41.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,44.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,42.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,41.68,448,,facility
SYPHILIS TEST NON-TREP QUAL,86592,CPT,302,RC,,,,outpatient,,,51.6,5.16,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.8,3.8,3.8,262,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,28.8,3.16,28.8,20,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,26.55,26.4,79.65,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,28.8,28.8,28.8,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,23.76,15.12,23.76,39,percent of total billed charges,,,33.6,,15.17,15.12,45.36,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,15.12,15.12,15.17,34,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,8.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,22.38,22.38,22.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.8,3.8,3.8,282,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.22,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,4.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,4.27,448,,facility
ASSAY OF BETA-2 PROTEIN,82232,CPT,301,RC,,,,outpatient,,,35.8,3.58,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,14.39,14.39,14.39,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,85.34,23.52,86.11,1 through 10,percent of total billed charges,,,34.6,,92.2,92.2,96.77,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,33.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,14.39,0.22,14.39,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,34.95,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,16.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,16.18,448,,facility
ASSAY OF CALCIUM IN URINE,82340,CPT,301,RC,,,,outpatient,,,39,3.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.36,5.36,5.36,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,19.15,19.15,123.98,1 through 10,percent of total billed charges,,,33.6,,123.98,123.98,123.98,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,19.15,19.15,19.15,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,12.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.36,5.36,5.36,54,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.02,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,6.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,6.03,448,,facility
BENZODIAZEPINES 13 OR MORE,80347,CPT,301,RC,,,,outpatient,,,40,4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
B CELLS TOTAL COUNT,86355,CPT,302,RC,,,,outpatient,,,173,17.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,33.56,33.56,33.56,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,60.77,60.77,60.77,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,37.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,37.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,27.98,27.98,27.98,1 through 10,percent of total billed charges,,,33.6,,33.56,33.56,33.56,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,63.63,63.63,63.63,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,78.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,39.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,33.56,33.56,33.56,25,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,39.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,81.52,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,38.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,37.73,448,,facility
ASSAY OF BLOOD OSMOLALITY,83930,CPT,301,RC,,,,outpatient,,,17,1.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.88,5.88,5.88,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,16.13,16.13,85.34,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,13.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,7.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,24,24,24,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.88,5.88,5.88,11,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,7.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.28,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,6.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,6.61,448,,facility
MOPATH PROCEDURE LEVEL 7,81406,CPT,310,RC,,,,outpatient,,,910,91,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,282.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,282.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,291.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,282.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,591.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,299.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,282.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,299.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,495.04,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,288.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,282.88,591.22,,facility
MOPATH PROCEDURE LEVEL 8,81407,CPT,310,RC,,,,outpatient,,,1270,127,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,846.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,846.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,871.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,846.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1768.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,897.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,846.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,897.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1480.97,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,863.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1768.7,,facility
ASSAY OF AMMONIA,82140,CPT,301,RC,,,,outpatient,,,16,1.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.96,12.96,12.96,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,65.18,29.57,110.77,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,29.92,29.92,29.92,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,30.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.96,12.96,12.96,51,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,31.48,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.57,448,,facility
IMMUNOASSAY NONANTIBODY,83516,CPT,301,RC,,,,outpatient,,,56,5.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9,9,10.26,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,4.75,4.75,218.59,30,percent of total billed charges,,,33.6,,3.02,3.02,175.39,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,3.02,3.02,211.68,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,24.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,23.5,23.5,23.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9,9,10.26,51,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.92,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,11.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.53,448,,facility
CHIMERISM ANAL NO CELL SELEC,81267,CPT,310,RC,,,,outpatient,,,273,27.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,184.53,184.53,184.53,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,207.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,207.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,213.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,1059.7,1059.7,1059.7,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,207.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,433.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,219.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,184.53,184.53,391.84,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,207.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,219.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,448.21,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,211.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,207.46,448.21,,facility
ASSAY OF VASOPRESSIN,84588,CPT,301,RC,,,,outpatient,,,50,5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,33.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,33.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,34.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,33.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,70.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,46.5,46.5,46.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,30.19,30.19,30.19,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,33.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,73.33,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,34.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,33.94,448,,facility
CLOT FACTOR II PROTHROM SPEC,85210,CPT,305,RC,,,,outpatient,,,85.5,8.55,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.55,11.55,11.55,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.55,11.55,11.55,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.05,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.98,448,,facility
ASSAY OF MAGNESIUM,83735,CPT,301,RC,,,,outpatient,,,41,4.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.96,5.96,5.96,292,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,9.38,5.96,25.37,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,197.47,22.7,213.55,144,percent of total billed charges,,,33.6,,125.66,125.66,126.79,59,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,125.66,14.45,142.49,154,percent of total billed charges,,,34.6,,135.76,135.76,142.49,1 through 10,percent of total billed charges,,,45,,5.96,5.96,5.96,1 through 10,percent of total billed charges,,6.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,7.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,21.5,21.5,187,13,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,78.54,78.54,78.54,21,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.96,5.96,5.96,1555,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,7.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.47,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,6.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,6.7,448,,facility
ASSAY OF CORTICOSTERONE,82528,CPT,301,RC,,,,outpatient,,,62.8,6.28,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,23.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,47.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,23.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,23.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,48.65,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,22.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,22.52,448,,facility
ASSAY OF FOLIC ACID RBC,82747,CPT,301,RC,,,,outpatient,,,26.25,2.63,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.7,15.7,15.7,27,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,36.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.7,15.7,15.7,76,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,37.42,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.65,448,,facility
COMPLEMENT ANTIGEN,86160,CPT,302,RC,,,,outpatient,,,40.2,4.02,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.67,10.67,10.67,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,87.32,87.32,87.32,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,78.14,49.73,270.86,17,percent of total billed charges,,,33.6,,49.73,49.73,172.37,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,49.73,29.23,50.32,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,256.5,256.5,256.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.67,10.67,10.67,61,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.92,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12,448,,facility
IMMUNOASSAY NONANTIBODY,83516,CPT,301,RC,,,,outpatient,,,134,13.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9,9,10.26,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,4.75,4.75,218.59,30,percent of total billed charges,,,33.6,,3.02,3.02,175.39,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,3.02,3.02,211.68,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,24.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,23.5,23.5,23.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9,9,10.26,51,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.92,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,11.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.53,448,,facility
MOPATH PROCEDURE LEVEL 4,81403,CPT,310,RC,,,,outpatient,,,314,31.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,185.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,185.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,190.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,322.39,322.39,322.39,1 through 10,percent of total billed charges,,,34.6,,397.12,397.12,397.12,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,185.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,387.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,196.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,185.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,196.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,324.1,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,188.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,185.2,448,,facility
ASSAY OF URINE SULFATE,84392,CPT,301,RC,,,,outpatient,,,38,3.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,11.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.26,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.49,448,,facility
IMMUNOASSAY NONANTIBODY,83516,CPT,301,RC,,,,outpatient,,,265,26.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9,9,10.26,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,4.75,4.75,218.59,30,percent of total billed charges,,,33.6,,3.02,3.02,175.39,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,3.02,3.02,211.68,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,24.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,23.5,23.5,23.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9,9,10.26,51,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.92,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,11.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.53,448,,facility
QUANTITATIVE ASSAY DRUG,80299,CPT,301,RC,,,,outpatient,,,39.5,3.95,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,13,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,174.64,174.64,174.64,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,171.6,171.6,171.6,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,374.52,374.52,374.52,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.62,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.64,448,,facility
HLA I TYPING COMPLETE LR,81372,CPT,300,RC,,,,outpatient,,,404,40.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,403.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,403.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,415.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,403.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,843.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,427.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,403.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,427.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,706.28,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,411.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,403.59,843.5,,facility
DRUG SCREENING BUPRENORPHINE,80348,CPT,301,RC,,,,outpatient,,,176,17.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
TRICHOMONAS VAGIN DIR PROBE,87660,CPT,306,RC,,,,outpatient,,,91,9.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,20.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,41.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,21.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,20.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,21.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,43.33,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,20.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,20.05,448,,facility
ASSAY IGA/IGD/IGG/IGM EACH,82784,CPT,301,RC,,,,outpatient,,,21.85,2.19,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,8.27,8.27,8.27,98,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,114.46,59,343.38,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,52.8,30.49,158.4,64,percent of total billed charges,,,33.6,,19.58,19.49,33.6,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,53.09,19.49,195.55,67,percent of total billed charges,,,34.6,,190.57,73.91,336.04,67,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,9.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,19.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,9.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,29,29,50,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,8.27,8.27,8.27,371,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,9.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,9.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.09,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,9.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,9.3,448,,facility
LYMPHOCYTE TRANSFORMATION,86353,CPT,302,RC,,,,outpatient,,,50,5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,49.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,49.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,50.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,49.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,102.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,51.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,49.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,51.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,105.93,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,50.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,49.03,448,,facility
METHYLENEDIOXYAMPHETAMINES,80359,CPT,301,RC,,,,outpatient,,,40,4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
ACETYLCHOLINESTERASE ASSAY,82013,CPT,301,RC,,,,outpatient,,,144,14.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.13,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.29,448,,facility
KETAMINE AND NORKETAMINE,80357,CPT,301,RC,,,,outpatient,,,63,6.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
DETECT AGENT NOS DNA QUANT,87799,CPT,306,RC,,,,outpatient,,,255,25.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,38.11,38.11,38.11,39,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,44.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,200.64,91.44,597.79,1 through 10,percent of total billed charges,,,33.6,,203.95,203.95,203.95,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,231.27,203.95,231.27,11,percent of total billed charges,,,34.6,,220.34,220.34,231.27,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,89.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,45.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,38.11,38.11,38.11,221,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,45.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,92.54,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,43.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,42.84,448,,facility
ASSAY OF METANEPHRINES,83835,CPT,301,RC,,,,outpatient,,,33.25,3.33,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.07,15.07,15.07,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,32.45,32.45,32.45,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,35.28,35.28,35.28,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,35.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.07,15.07,15.07,11,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.61,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,16.94,448,,facility
LIPID PANEL,80061,CPT,301,RC,,,,outpatient,,,49,4.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.91,11.91,11.91,1021,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,34.81,34.81,34.81,26,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,37.76,37.76,37.76,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,31.15,19.82,31.15,172,percent of total billed charges,,,33.6,,20,19.82,31.15,37,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,19.82,19.82,20,389,percent of total billed charges,,,34.6,,21.83,21.83,21.83,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,29.5,29.5,123.5,11,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,12.39,12.39,51.87,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.91,11.91,11.91,1133,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.93,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.39,448,,facility
ASSAY OF MERCURY,83825,CPT,301,RC,,,,outpatient,,,63.8,6.38,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,14.46,14.46,14.46,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,33.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,14.46,14.46,14.46,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.12,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,16.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,16.26,448,,facility
NFCT AGT GNTYP ALYS HIV1,87906,CPT,306,RC,,,,outpatient,,,358,35.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,120.95,120.95,120.95,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,128.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,128.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,132.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,108.24,108.24,108.24,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,128.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,269.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,136.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,114.5,114.5,114.5,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,128.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,136.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,278.11,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,131.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,128.73,448,,facility
OPIATES 1 OR MORE,80361,CPT,301,RC,,,,outpatient,,,246,24.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
HELMINTH ANTIBODY,86682,CPT,302,RC,,,,outpatient,,,111,11.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.57,11.57,11.57,36,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,56.78,56.78,66.44,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.57,11.57,11.57,12,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.11,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.01,448,,facility
COMPLEMENT ANTIGEN,86160,CPT,302,RC,,,,outpatient,,,15,1.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.67,10.67,10.67,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,87.32,87.32,87.32,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,78.14,49.73,270.86,17,percent of total billed charges,,,33.6,,49.73,49.73,172.37,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,49.73,29.23,50.32,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,256.5,256.5,256.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.67,10.67,10.67,61,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.92,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12,448,,facility
ASSAY OF TRANSCORTIN,84449,CPT,301,RC,,,,outpatient,,,43,4.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,37.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.89,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18,448,,facility
ASSAY OF ESTRIOL,82677,CPT,301,RC,,,,outpatient,,,52,5.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,21.51,21.51,21.51,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,7.73,7.73,7.73,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,24.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,50.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,25.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,21.51,21.51,51.51,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,24.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,25.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,52.24,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,24.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,24.18,448,,facility
IMMUNOASSAY NONANTIBODY,83516,CPT,301,RC,,,,outpatient,,,395,39.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9,9,10.26,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,4.75,4.75,218.59,30,percent of total billed charges,,,33.6,,3.02,3.02,175.39,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,3.02,3.02,211.68,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,24.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,23.5,23.5,23.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9,9,10.26,51,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.92,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,11.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.53,448,,facility
PML/RARALPHA COM BREAKPOINTS,81315,CPT,310,RC,,,,outpatient,,,485,48.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,184.4,184.4,184.4,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,207.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,207.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,213.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,207.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,433.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,219.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,184.4,184.4,184.4,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,207.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,219.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,447.9,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,211.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,207.31,448,,facility
STOOL CULTR AEROBIC BACT EA,87046,CPT,306,RC,,,,outpatient,,,30.5,3.05,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,62.83,62.83,62.83,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,9.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,19.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,9.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.41,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,9.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,9.44,448,,facility
IMMUNOASSAY INFECTIOUS AGENT,86317,CPT,302,RC,,,,outpatient,,,26,2.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.33,13.33,13.33,86,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,59,59,59,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,52.8,26.54,52.8,41,percent of total billed charges,,,33.6,,52.8,33.6,52.8,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,33.6,33.6,33.73,52,percent of total billed charges,,,34.6,,218.53,218.53,218.53,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,31.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,50,50,50,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.33,13.33,13.33,209,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.38,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,15.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.99,448,,facility
KRAS GENE VARIANTS EXON 2,81275,CPT,310,RC,,,,outpatient,,,500,50,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,193.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,193.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,199.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,193.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,403.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,204.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,193.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,204.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,338.19,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,197.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,193.25,448,,facility
ASSAY FOR PHENCYCLIDINE,83992,CPT,301,RC,,,,outpatient,,,615,61.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.6,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,75.6,448,,facility
IMMUNOASSAY TUMOR OTHER,86316,CPT,302,RC,,,,outpatient,,,55.25,5.53,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,18.51,18.51,18.51,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,76.03,32.21,76.03,1 through 10,percent of total billed charges,,,33.6,,48.38,48.38,48.38,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,20.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,43.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,18.51,18.51,18.51,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,20.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,44.98,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,21.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,20.81,448,,facility
SKELETAL MUSCLE RELAXANT 1/2,80369,CPT,301,RC,,,,outpatient,,,45.9,4.59,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
ASSAY NEPHELOMETRY NOT SPEC,83883,CPT,301,RC,,,,outpatient,,,148.2,14.82,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.1,12.1,12.1,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,173.18,51.22,173.18,1 through 10,percent of total billed charges,,,33.6,,31.58,31.58,31.58,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,31.58,31.53,110.21,11,percent of total billed charges,,,34.6,,119.06,117.35,124.97,24,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,28.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.1,12.1,12.1,29,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.38,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.6,448,,facility
HEAVY METAL QUAN EACH NES,83018,CPT,301,RC,,,,outpatient,,,183,18.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,21.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,45.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,23.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,21.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,23.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,47.46,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,22.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,21.96,448,,facility
MYCOBACTERIA DNA AMP PROBE,87551,CPT,306,RC,,,,outpatient,,,380.9,38.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,48.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,48.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,49.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,48.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,100.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,51.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,48.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,51.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,84.42,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,49.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,48.24,448,,facility
PHENOTYPE INFECT AGENT DRUG,87900,CPT,306,RC,,,,outpatient,,,369,36.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,130.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,130.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,134.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,130.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,272.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,138.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,130.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,138.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,281.61,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,132.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,130.35,448,,facility
ASSAY OF ARSENIC,82175,CPT,301,RC,,,,outpatient,,,105,10.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.87,16.87,16.87,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,39.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,20.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.87,16.87,16.87,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,20.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,40.99,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.97,448,,facility
SMEAR COMPLEX STAIN,87209,CPT,306,RC,,,,outpatient,,,8,0.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15,15,15.99,19,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,9.6,9.6,9.6,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,7.92,5.04,7.92,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,5.04,5.04,5.04,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,37.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15,15,15.99,18,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.98,448,,facility
STR MARKERS SPEC ANAL ADDL,81266,CPT,310,RC,,,,outpatient,,,275,27.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,304.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,304.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,313.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,304.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,637.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,323.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,304.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,323.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,533.42,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,310.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,304.81,637.05,,facility
DRUG SCRN QUAN MYCOPHENOLATE,80180,CPT,301,RC,,,,outpatient,,,97.75,9.78,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,37.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.06,16.06,16.06,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.99,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.05,448,,facility
WHOLE MITOCHONDRIAL GENOME,81460,CPT,310,RC,,,,outpatient,,,250,25,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1287,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1287,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1325.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1287,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,2689.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1364.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1287,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1364.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2252.25,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1312.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,2689.83,,facility
SALMONELLA ANTIBODY,86768,CPT,302,RC,,,,outpatient,,,24.6,2.46,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.49,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.19,448,,facility
ACETYLCHOLN RCPTR BNDNG ANTB,86041,CPT,302,RC,,,,outpatient,,,56,5.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.37,16.37,16.37,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.2,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.4,448,,facility
DRUG SCREEN QUANT GABAPENTIN,80171,CPT,301,RC,,,,outpatient,,,33.15,3.32,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,21.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,45.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,21.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,37.92,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,22.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,21.67,448,,facility
LYME DISEASE ANTIBODY,86617,CPT,302,RC,,,,outpatient,,,30,3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,25.26,25.26,25.26,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,32.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.78,13.78,13.78,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,33.48,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,15.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,15.49,448,,facility
MUMPS ANTIBODY,86735,CPT,302,RC,,,,outpatient,,,64.5,6.45,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.61,11.61,11.61,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,22.18,22.18,85.01,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,68.61,68.61,68.61,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,44,44,44,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.61,11.61,11.61,15,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.19,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.05,448,,facility
DRUG SCREENING BARBITURATES,80345,CPT,301,RC,,,,outpatient,,,213,21.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
HGB METHEMOGLOBIN QUAN,83050,CPT,301,RC,,,,outpatient,,,45,4.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,17.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.84,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,8.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,8.2,448,,facility
TOXOPLASMA ANTIBODY,86777,CPT,302,RC,,,,outpatient,,,35,3.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.8,12.8,12.8,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,64.42,64.42,64.42,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,30.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.8,12.8,12.8,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,31.1,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.39,448,,facility
ASSAY OF CALCIUM,82310,CPT,301,RC,,,,outpatient,,,4.5,0.45,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.59,4.59,4.59,15,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,28.32,28.32,28.32,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,16.13,16.13,50.25,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,16.13,16.13,114.24,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,10.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,71.4,71.4,71.4,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.59,4.59,4.59,27,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.15,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.16,448,,facility
BODY FLUID SPECIFIC GRAVITY,84315,CPT,301,RC,,,,outpatient,,,8,0.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,6.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.74,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,3.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,3.28,448,,facility
NK CELLS TOTAL COUNT,86357,CPT,302,RC,,,,outpatient,,,316.5,31.65,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,33.56,33.56,33.56,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,60.77,60.77,60.77,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,37.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,37.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,27.98,27.98,27.98,1 through 10,percent of total billed charges,,,33.6,,33.56,33.56,33.56,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,537.59,537.59,537.59,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,78.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,39.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,33.56,33.56,33.56,25,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,39.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,81.52,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,38.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,37.73,448,,facility
BL SMEAR W/DIFF WBC COUNT,85007,CPT,305,RC,,,,outpatient,,,18.45,1.85,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.38,3.38,3.38,135,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,407.04,8.32,467.84,76,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,7.67,7.67,431.29,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,385.97,6.86,417.4,56,percent of total billed charges,,,33.6,,245.62,245.62,245.62,33,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,242.32,4.37,245.62,60,percent of total billed charges,,,34.6,,265.35,265.35,265.35,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,7.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,6.5,3.38,365.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,153.51,153.51,153.51,1 through 10,percent of total billed charges,,,35,,318,318,318,1 through 10,percent of total billed charges,,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.38,3.38,3.38,861,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.42,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,3.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,3.8,448,,facility
HEMOGLOBIN ELECTROPHORESIS,83020,CPT,301,RC,,,,outpatient,,,101,10.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.45,11.45,11.45,22,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,12.1,12.1,12.29,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,26.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,18,18,18,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,29.19,29.19,29.19,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.45,11.45,11.45,47,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.81,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.87,448,,facility
HTLV-II ANTIBODY,86688,CPT,302,RC,,,,outpatient,,,256,25.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,29.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.26,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14,448,,facility
CYP2D6 GENE COM VARIANTS,81226,CPT,310,RC,,,,outpatient,,,426.85,42.69,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,450.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,450.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,464.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,450.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,942.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,477.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,450.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,477.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,789.09,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,459.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,942.4,,facility
PROTHROMBIN TIME,85610,CPT,305,RC,,,,outpatient,,,46,4.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.82,3.82,3.82,148,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,25.6,25.6,68.48,85,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,63.13,63.13,63.13,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,35.95,16.37,61.1,101,percent of total billed charges,,,33.6,,21.12,13.44,56.5,20,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,13.56,13.44,36.27,76,percent of total billed charges,,,34.6,,38.84,38.84,40.77,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,8.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,53.5,20,141,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,22.47,8.4,22.47,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.82,3.82,3.82,801,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.49,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,4.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,4.29,448,,facility
ENCEPHALTIS WEST EQNE ANTBDY,86654,CPT,302,RC,,,,outpatient,,,41.6,4.16,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.49,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.19,448,,facility
DRUG SCREENING PROPOXYPHENE,80367,CPT,301,RC,,,,outpatient,,,213,21.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
LYMPH CHORIOMENINGITIS AB,86727,CPT,302,RC,,,,outpatient,,,45.3,4.53,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,26.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.81,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.87,448,,facility
THROMBOPLASTIN TIME PARTIAL,85732,CPT,305,RC,,,,outpatient,,,51,5.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.75,5.75,5.75,18,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,24.29,15.46,83.95,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,15.46,15.46,15.46,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,13.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.75,5.75,5.75,33,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.97,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,6.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,6.47,448,,facility
MYCOPLASMA,87109,CPT,306,RC,,,,outpatient,,,50,5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.69,13.69,13.69,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,32.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.69,13.69,13.69,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,33.25,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,15.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,15.39,448,,facility
HEPATITIS A IGM ANTIBODY,86709,CPT,302,RC,,,,outpatient,,,16,1.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.02,10.02,10.02,22,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,76.16,76.16,76.16,19,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,70.21,70.21,70.21,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,62.83,62.83,62.83,1 through 10,percent of total billed charges,,,33.6,,39.98,39.98,62.83,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,39.98,39.98,40.34,13,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,23.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,59.5,59.5,59.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.02,10.02,10.02,66,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.33,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,11.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.26,448,,facility
CHROMOSOME ANALYSIS 100,88249,CPT,311,RC,,,,outpatient,,,450,45,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,173.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,173.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,178.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,173.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,361.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,183.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,173.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,183.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,374.15,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,176.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,173.17,448,,facility
HIV-1 QUANT&REVRSE TRNSCRPJ,87536,CPT,306,RC,,,,outpatient,,,120,12,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,75.7,75.7,75.7,61,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,115.05,115.05,369.93,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,124.8,124.8,124.8,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,85.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,85.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,87.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,102.96,65.52,102.96,24,percent of total billed charges,,,33.6,,102.96,65.52,331.06,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,65.52,65.52,66.11,15,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,85.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,177.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,90.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,97.5,97.5,97.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,75.7,75.7,75.7,201,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,85.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,90.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,183.86,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,86.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,85.1,448,,facility
ASSAY OF MAGNESIUM,83735,CPT,301,RC,,,,outpatient,,,4,0.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.96,5.96,5.96,292,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,9.38,5.96,25.37,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,197.47,22.7,213.55,144,percent of total billed charges,,,33.6,,125.66,125.66,126.79,59,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,125.66,14.45,142.49,154,percent of total billed charges,,,34.6,,135.76,135.76,142.49,1 through 10,percent of total billed charges,,,45,,5.96,5.96,5.96,1 through 10,percent of total billed charges,,6.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,7.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,21.5,21.5,187,13,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,78.54,78.54,78.54,21,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.96,5.96,5.96,1555,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,7.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.47,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,6.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,6.7,448,,facility
ASSAY BLOOD CARBON DIOXIDE,82374,CPT,301,RC,,,,outpatient,,,4.5,0.45,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.34,4.34,4.34,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,9.76,9.76,9.76,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,48.54,28.56,48.54,1 through 10,percent of total billed charges,,,33.6,,28.56,28.56,28.56,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,28.57,28.56,57.12,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,10.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.34,4.34,4.34,35,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.55,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,4.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,4.88,448,,facility
ASSAY OF AMYLASE,82150,CPT,301,RC,,,,outpatient,,,24.8,2.48,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.76,5.76,5.76,19,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,95,95,95,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,54.24,31.92,54.25,46,percent of total billed charges,,,33.6,,31.92,27.12,54.24,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,31.92,27.12,31.92,11,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,13.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,40,40,47.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.76,5.76,5.76,306,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,6.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,6.48,448,,facility
BILE ACIDS TOTAL,82239,CPT,301,RC,,,,outpatient,,,1074.5,107.45,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.23,15.23,15.23,11,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,21.02,21.02,87.36,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,35.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,31,31,31,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.23,15.23,15.23,20,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,37,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.12,448,,facility
ASSAY OF ZINC,84630,CPT,301,RC,,,,outpatient,,,40,4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.13,10.13,10.13,19,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,31.68,14.11,31.68,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,20.16,20.16,74.92,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,23.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,30,30,30,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.13,10.13,10.13,43,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.61,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,11.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.39,448,,facility
FUNGI IDENTIFICATION YEAST,87106,CPT,306,RC,,,,outpatient,,,10,1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,21.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9.18,9.18,9.18,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.3,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,10.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,10.32,448,,facility
IMMUNOASSAY INFECTIOUS AGENT,86317,CPT,302,RC,,,,outpatient,,,47,4.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.33,13.33,13.33,86,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,59,59,59,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,52.8,26.54,52.8,41,percent of total billed charges,,,33.6,,52.8,33.6,52.8,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,33.6,33.6,33.73,52,percent of total billed charges,,,34.6,,218.53,218.53,218.53,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,31.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,50,50,50,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.33,13.33,13.33,209,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.38,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,15.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.99,448,,facility
MLH1 GENE DUP/DELETE VARIANT,81294,CPT,310,RC,,,,outpatient,,,72,7.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,202.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,202.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,208.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,202.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,423.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,214.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,202.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,214.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,354.2,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,206.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,202.4,448,,facility
AMPHETAMINES 5 OR MORE,80326,CPT,301,RC,,,,outpatient,,,40,4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
HEPATITIS DELTA AGENT ANTBDY,86692,CPT,302,RC,,,,outpatient,,,50,5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,35.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,37.08,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.16,448,,facility
PINWORM EXAM,87172,CPT,306,RC,,,,outpatient,,,8.56,0.86,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,8.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.22,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,4.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,4.27,448,,facility
DETECT AGENT NOS DNA QUANT,87799,CPT,306,RC,,,,outpatient,,,180,18,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,38.11,38.11,38.11,39,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,44.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,200.64,91.44,597.79,1 through 10,percent of total billed charges,,,33.6,,203.95,203.95,203.95,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,231.27,203.95,231.27,11,percent of total billed charges,,,34.6,,220.34,220.34,231.27,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,89.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,45.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,38.11,38.11,38.11,221,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,45.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,92.54,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,43.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,42.84,448,,facility
ASSAY OF URINE VMA,84585,CPT,301,RC,,,,outpatient,,,38.4,3.84,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.79,13.79,13.79,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,32.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.79,13.79,13.79,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,33.48,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,15.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,15.5,448,,facility
NFCT AGT GNTYP ALYS HEP B,87912,CPT,306,RC,,,,outpatient,,,278.6,27.86,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,257.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,257.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,265.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,257.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,538.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,272.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,257.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,272.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,556.22,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,262.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,257.45,556.22,,facility
SEDATIVE HYPNOTICS,80368,CPT,301,RC,,,,outpatient,,,35,3.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
FLUORESCENT ANTIBODY SCREEN,86255,CPT,302,RC,,,,outpatient,,,62,6.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.72,10.72,10.72,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,45.41,28.9,1068.67,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,28.9,28.9,28.9,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.72,10.72,10.72,19,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.04,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.05,448,,facility
ASSAY C-D TRANSFER MEASURE,82373,CPT,301,RC,,,,outpatient,,,321.7,32.17,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,37.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,39.01,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.06,448,,facility
ANTIDEPRESSANT TRICYCLIC 1/2,80335,CPT,301,RC,,,,outpatient,,,31.25,3.13,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
QUANTITATIVE ASSAY DRUG,80299,CPT,301,RC,,,,outpatient,,,76.5,7.65,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,13,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,174.64,174.64,174.64,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,171.6,171.6,171.6,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,374.52,374.52,374.52,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.62,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.64,448,,facility
CLOT FACTOR X STUART-POWER,85260,CPT,305,RC,,,,outpatient,,,50,5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,37.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.92,0.22,15.92,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.68,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.9,448,,facility
NUCLEAR ANTIGEN ANTIBODY,86235,CPT,302,RC,,,,outpatient,,,204,20.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13,12.5,15.95,11,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,54.91,4.37,90.29,43,percent of total billed charges,,,33.6,,4.37,4.37,53.09,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,22.18,4.24,83.33,13,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,37.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.95,13,15.95,54,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.75,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.93,448,,facility
HEPATITIS DELTA AGENT ANTBDY,86692,CPT,302,RC,,,,outpatient,,,193,19.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,35.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,37.08,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.16,448,,facility
MOPATH PROCEDURE LEVEL 7,81406,CPT,310,RC,,,,outpatient,,,449,44.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,282.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,282.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,291.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,282.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,591.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,299.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,282.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,299.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,495.04,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,288.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,282.88,591.22,,facility
FIBRINOGEN ANTIGEN,85385,CPT,305,RC,,,,outpatient,,,50,5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.86,12.86,12.86,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,30.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.86,12.86,12.86,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.31,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.46,448,,facility
ASSAY OTHER FLUID CHLORIDES,82438,CPT,301,RC,,,,outpatient,,,4.5,0.45,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,10.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.55,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5,448,,facility
ENZYME CELL ACTIVITY,82657,CPT,301,RC,,,,outpatient,,,775,77.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.72,19.72,19.72,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,2094.14,2094.14,2094.14,1 through 10,percent of total billed charges,,,33.6,,762.96,762.96,762.96,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,46.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,23.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.72,19.72,19.72,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,23.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,39.01,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,22.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,22.17,448,,facility
ASSAY OF IGE,82785,CPT,301,RC,,,,outpatient,,,39.46,3.95,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,14.64,14.64,14.64,32,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,44.88,28.56,175.87,1 through 10,percent of total billed charges,,,33.6,,124.52,124.52,124.52,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,28.56,28.56,28.56,1 through 10,percent of total billed charges,,,34.6,,32.29,32.29,117.35,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,34.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,14.64,14.64,14.64,106,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.56,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,16.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,16.46,448,,facility
ASSAY OF MAGNESIUM,83735,CPT,301,RC,,,,outpatient,,,7,0.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.96,5.96,5.96,292,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,9.38,5.96,25.37,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,197.47,22.7,213.55,144,percent of total billed charges,,,33.6,,125.66,125.66,126.79,59,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,125.66,14.45,142.49,154,percent of total billed charges,,,34.6,,135.76,135.76,142.49,1 through 10,percent of total billed charges,,,45,,5.96,5.96,5.96,1 through 10,percent of total billed charges,,6.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,7.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,21.5,21.5,187,13,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,78.54,78.54,78.54,21,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.96,5.96,5.96,1555,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,7.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.47,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,6.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,6.7,448,,facility
ALLG SPEC IGE CRUDE XTRC EA,86003,CPT,302,RC,,,,outpatient,,,16,1.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.64,4.64,4.64,14,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,77.88,77.88,77.88,12,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,110.88,18.14,178.46,68,percent of total billed charges,,,33.6,,110.88,110.88,110.88,30,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,110.88,44.35,161.62,185,percent of total billed charges,,,34.6,,125.73,125.73,125.73,30,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,10.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.64,4.64,4.64,26,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.27,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.22,448,,facility
UNLISTED CHEMISTRY PROCEDURE,84999,CPT,301,RC,,,,outpatient,,,20,2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
TREPONEMA PALLIDUM,86780,CPT,302,RC,,,,outpatient,,,119,11.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.78,11.78,11.78,612,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,10.62,10.62,50.15,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,9.5,6.05,48.53,46,percent of total billed charges,,,33.6,,6.05,6.05,44.88,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,6.05,6.05,28.56,66,percent of total billed charges,,,34.6,,73.69,20.19,77.34,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,9,9,42.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,17.85,17.85,17.85,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,11.78,11.78,11.78,1 through 10,percent of total billed charges,,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.78,11.78,11.78,550,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.6,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.24,448,,facility
QUANTITATIVE ASSAY DRUG,80299,CPT,301,RC,,,,outpatient,,,142.5,14.25,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,13,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,174.64,174.64,174.64,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,171.6,171.6,171.6,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,374.52,374.52,374.52,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.62,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.64,448,,facility
IMMUNOASSAY INFECTIOUS AGENT,86317,CPT,302,RC,,,,outpatient,,,21.48,2.15,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.33,13.33,13.33,86,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,59,59,59,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,52.8,26.54,52.8,41,percent of total billed charges,,,33.6,,52.8,33.6,52.8,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,33.6,33.6,33.73,52,percent of total billed charges,,,34.6,,218.53,218.53,218.53,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,31.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,50,50,50,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.33,13.33,13.33,209,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.38,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,15.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.99,448,,facility
VARICELLA-ZOSTER ANTIBODY,86787,CPT,302,RC,,,,outpatient,,,13,1.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.46,11.46,11.46,39,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,82.6,23.01,82.6,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,47.54,20.59,129.19,22,percent of total billed charges,,,33.6,,47.04,47.04,266.64,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,47.04,47.04,47.54,21,percent of total billed charges,,,34.6,,221.19,221.19,221.19,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,26.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,70,70,252.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,24.36,24.36,24.36,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,11.46,11.46,11.46,1 through 10,percent of total billed charges,,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.46,11.46,11.46,200,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.88,448,,facility
TB TEST CELL IMMUN MEASURE,86480,CPT,302,RC,,,,outpatient,,,82.5,8.25,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,55.13,55.13,55.13,82,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,64.9,45.87,225.38,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,61.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,61.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,63.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,58.08,58.08,201.7,24,percent of total billed charges,,,33.6,,58.08,36.96,58.08,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,36.96,36.96,99.67,22,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,61.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,129.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,65.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,55,55,55,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,55.13,55.13,55.13,131,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,61.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,65.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,133.91,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,63.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,61.98,448,,facility
DRUG SCREEN QUANTALCOHOLS,80320,CPT,301,RC,,,,outpatient,,,45,4.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
MOPATH PROCEDURE LEVEL 4,81403,CPT,310,RC,,,,outpatient,,,18,1.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,185.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,185.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,190.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,322.39,322.39,322.39,1 through 10,percent of total billed charges,,,34.6,,397.12,397.12,397.12,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,185.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,387.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,196.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,185.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,196.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,324.1,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,188.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,185.2,448,,facility
EXOME SEQUENCE ANALYSIS,81415,CPT,310,RC,,,,outpatient,,,860,86,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4780,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4780,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4923.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4780,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,9990.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5066.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4780,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5066.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8365,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,4875.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,9990.2,,facility
AMINO ACIDS QUANT 2-5,82136,CPT,301,RC,,,,outpatient,,,75,7.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,17.44,17.44,17.44,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,44.41,44.41,44.41,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,40.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,20.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,24.51,24.51,24.51,1 through 10,percent of total billed charges,,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,17.44,17.44,17.44,23,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,20.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.45,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,20,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,19.61,448,,facility
CLOT FACTOR II PROTHROM SPEC,85210,CPT,305,RC,,,,outpatient,,,235,23.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.55,11.55,11.55,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.55,11.55,11.55,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.05,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.98,448,,facility
SC STD AGAR DILUTION PER AGT,87181,CPT,306,RC,,,,outpatient,,,8,0.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,9.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.26,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,4.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,4.75,448,,facility
ASSAY AMINOLEVULINIC ACID,82135,CPT,301,RC,,,,outpatient,,,82,8.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,14.63,14.63,14.63,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,34.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.54,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,16.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,16.45,448,,facility
DRUG TEST PRSMV CHEM ANLYZR,80307,CPT,301,RC,,,,outpatient,,,51,5.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,55.27,55.27,55.27,34,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,62.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,62.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,171.87,131.38,223.26,14,percent of total billed charges,,,33.6,,206.45,131.38,223.26,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,131.38,102.04,131.38,13,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,62.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,129.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,65.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,55.27,55.27,55.27,332,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,62.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,65.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,125.7,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,63.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,62.14,448,,facility
MOPATH PROCEDURE LEVEL 2,81401,CPT,310,RC,,,,outpatient,,,224,22.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,121.86,121.86,121.86,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,137,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,137,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,141.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,137,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,286.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,145.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,137,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,145.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,239.75,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,139.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,137,448,,facility
DRUG TEST PRSMV CHEM ANLYZR,80307,CPT,301,RC,,,,outpatient,,,160,16,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,55.27,55.27,55.27,34,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,62.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,62.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,171.87,131.38,223.26,14,percent of total billed charges,,,33.6,,206.45,131.38,223.26,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,131.38,102.04,131.38,13,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,62.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,129.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,65.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,55.27,55.27,55.27,332,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,62.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,65.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,125.7,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,63.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,62.14,448,,facility
DRUG TEST PRSMV CHEM ANLYZR,80307,CPT,301,RC,,,,outpatient,,,50,5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,55.27,55.27,55.27,34,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,62.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,62.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,171.87,131.38,223.26,14,percent of total billed charges,,,33.6,,206.45,131.38,223.26,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,131.38,102.04,131.38,13,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,62.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,129.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,65.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,55.27,55.27,55.27,332,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,62.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,65.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,125.7,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,63.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,62.14,448,,facility
MSH2 GENE DUP/DELETE VARIANT,81297,CPT,310,RC,,,,outpatient,,,75,7.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,213.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,213.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,219.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,213.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,445.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,226.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,213.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,226.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,373.28,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,217.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,213.3,448,,facility
ASSAY OF FREE THYROXINE,84439,CPT,301,RC,,,,outpatient,,,5.1,0.51,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,8.02,8.02,8.02,335,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,53.1,53.1,309.16,13,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,47.52,30.24,276.67,112,percent of total billed charges,,,33.6,,47.52,30.24,276.67,25,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,30.24,30.24,176.06,119,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,9.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,18.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,9.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,45.13,45,262,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,18.9,18.9,18.9,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,8.02,8.02,8.02,954,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,9.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,9.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.48,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,9.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,9.02,448,,facility
ASSAY FOR PHENCYCLIDINE,83992,CPT,301,RC,,,,outpatient,,,204,20.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.6,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,75.6,448,,facility
ASSAY OF NICKEL,83885,CPT,301,RC,,,,outpatient,,,128,12.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,24.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,51.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,25.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,24.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,25.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,52.96,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,24.51,448,,facility
NUCLEAR ANTIGEN ANTIBODY,86235,CPT,302,RC,,,,outpatient,,,98,9.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13,12.5,15.95,11,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,54.91,4.37,90.29,43,percent of total billed charges,,,33.6,,4.37,4.37,53.09,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,22.18,4.24,83.33,13,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,37.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.95,13,15.95,54,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.75,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.93,448,,facility
ASSAY OF LRH HORMONE,83727,CPT,301,RC,,,,outpatient,,,315,31.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,35.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,37.14,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.19,448,,facility
METHYLPHENIDATE,80360,CPT,301,RC,,,,outpatient,,,40,4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
CELL FUNCTION ASSAY W/STIM,86352,CPT,302,RC,,,,outpatient,,,185,18.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,135.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,135.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,139.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,210.52,210.52,210.52,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,135.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,283.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,144.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,120.85,120.85,120.85,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,135.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,144.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,293.53,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,138.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,135.86,448,,facility
CANDIDA DNA DIR PROBE,87480,CPT,306,RC,,,,outpatient,,,91,9.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,20.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,41.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,21.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,20.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,21.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,43.33,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,20.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,20.05,448,,facility
ASSAY OF 17-HYDROXYPREGNENO,84143,CPT,301,RC,,,,outpatient,,,59.15,5.92,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,20.29,20.29,20.29,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,23.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,47.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,24.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,20.29,20.29,20.29,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,24.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,49.28,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,23.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,22.81,448,,facility
THROMBIN TIME PLASMA,85670,CPT,305,RC,,,,outpatient,,,54,5.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,12.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.46,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.77,448,,facility
DEHYDROEPIANDROSTERONE,82626,CPT,301,RC,,,,outpatient,,,60.8,6.08,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,22.48,22.48,22.48,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,29.9,29.9,29.9,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,25.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,52.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,26.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,22.48,22.48,22.48,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,25.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,26.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,54.6,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,25.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,25.27,448,,facility
ASSAY PROSTATE PHOSPHATASE,84066,CPT,301,RC,,,,outpatient,,,34,3.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,9.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,20.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,9.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.88,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,9.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,9.66,448,,facility
IMMUNOASSAY QUANT NOS NONAB,83520,CPT,301,RC,,,,outpatient,,,260,26,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,36,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,66.08,66.08,66.08,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,41.18,24.82,318.38,1 through 10,percent of total billed charges,,,33.6,,37.63,37.63,96.43,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,33.6,23.18,176.4,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,36.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,87,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.22,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.27,448,,facility
HEAVY METAL QUAN EACH NES,83018,CPT,301,RC,,,,outpatient,,,105,10.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,21.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,45.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,23.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,21.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,23.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,47.46,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,22.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,21.96,448,,facility
CHLMYD PNEUM DNA AMP PROBE,87486,CPT,306,RC,,,,outpatient,,,244.75,24.48,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
DRUG TEST PRSMV CHEM ANLYZR,80307,CPT,301,RC,,,,outpatient,,,322,32.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,55.27,55.27,55.27,34,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,62.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,62.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,171.87,131.38,223.26,14,percent of total billed charges,,,33.6,,206.45,131.38,223.26,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,131.38,102.04,131.38,13,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,62.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,129.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,65.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,55.27,55.27,55.27,332,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,62.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,65.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,125.7,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,63.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,62.14,448,,facility
DRUG ASSAY RUFINAMIDE,80210,CPT,301,RC,,,,outpatient,,,90.45,9.05,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,27.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,56.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,28.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,27.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,28.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,47.44,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,27.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,27.11,448,,facility
ROTAVIRUS AG IA,87425,CPT,306,RC,,,,outpatient,,,144,14.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.9,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.98,448,,facility
CFTR GENE FULL SEQUENCE,81223,CPT,310,RC,,,,outpatient,,,1320,132,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,499,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,499,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,513.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,499,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1042.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,528.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,499,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,528.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,873.25,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,508.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1042.91,,facility
FXN GENE FULL GENE SEQUENCE,81286,CPT,310,RC,,,,outpatient,,,151,15.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,274.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,274.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,283.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,274.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,574.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,291.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,274.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,291.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,480.95,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,280.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,274.83,574.39,,facility
VIT D 1 25-DIHYDROXY,82652,CPT,301,RC,,,,outpatient,,,63.7,6.37,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,34.25,34.25,34.25,16,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,30.68,30.68,30.68,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,39.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,41.71,17.47,46.99,1 through 10,percent of total billed charges,,,33.6,,17.47,17.47,29.9,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,26.78,26.54,26.78,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,38.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,80.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,40.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,39.5,39.5,39.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,34.25,34.25,34.25,35,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,38.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,40.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.18,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,39.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,38.5,448,,facility
IMMUNOASSAY NONANTIBODY,83516,CPT,301,RC,,,,outpatient,,,130,13,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9,9,10.26,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,4.75,4.75,218.59,30,percent of total billed charges,,,33.6,,3.02,3.02,175.39,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,3.02,3.02,211.68,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,24.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,23.5,23.5,23.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9,9,10.26,51,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.92,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,11.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.53,448,,facility
BILIRUBIN DIRECT,82248,CPT,301,RC,,,,outpatient,,,4,0.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.47,4.47,4.47,154,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,19.47,19.47,160.48,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,17.42,17.42,155.31,44,percent of total billed charges,,,33.6,,11.09,11.09,143.62,18,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,91.39,11.09,91.39,51,percent of total billed charges,,,34.6,,103.63,103.63,190.4,1 through 10,percent of total billed charges,,,45,,4.47,4.47,4.47,1 through 10,percent of total billed charges,,5.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,10.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,16.5,16.5,16.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,6.93,6.93,6.93,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.47,4.47,4.47,656,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.02,448,,facility
OPIATES 1 OR MORE,80361,CPT,301,RC,,,,outpatient,,,40,4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
ANTINUCLEAR ANTIBODIES,86038,CPT,302,RC,,,,outpatient,,,33,3.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.75,10.75,10.75,34,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,148.09,148.09,148.09,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,84.34,29.04,132.53,14,percent of total billed charges,,,33.6,,84.34,18.48,127.78,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,84.34,84.34,85.09,12,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,11.55,11.55,11.55,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.75,10.75,10.75,126,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.11,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.09,448,,facility
THROMBOPLASTIN INHIBITION,85705,CPT,305,RC,,,,outpatient,,,181,18.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,9.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,20.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,9.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.81,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,9.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,9.63,448,,facility
MYCOBACTERIA CULTURE,87116,CPT,306,RC,,,,outpatient,,,72,7.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9.61,9.61,9.61,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,22.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9.61,9.61,9.61,23,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,23.35,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,11.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,10.8,448,,facility
NFCT AGT GNTYP ALYS HEP C,87902,CPT,306,RC,,,,outpatient,,,310,31,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,229,229,229,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,257.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,257.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,265.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,257.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,538.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,272.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,229,229,229,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,257.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,272.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,556.22,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,262.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,257.45,556.22,,facility
CHLAMYDIA ANTIBODY,86631,CPT,302,RC,,,,outpatient,,,100,10,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,24.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.55,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.82,448,,facility
ECHO EXAM OF FETAL HEART,76827,CPT,402,RC,,,,outpatient,,,130.94,13.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,1054.08,1054.08,1054.08,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,869.62,869.62,1739.23,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,465,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,465,,facility
ASSAY OF URINE/URIC ACID,84560,CPT,301,RC,,,,outpatient,,,6.35,0.64,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.52,4.52,4.52,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,10.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.26,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.08,448,,facility
APPL CST SHO TO HAND LNG ARM,29065,CPT,761,RC,,,,outpatient,,,319.85,31.99,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,267.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,267.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,275.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,267.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,559.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,283.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,267.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,283.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,273.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,267.68,559.45,,facility
FLUORO EXAM OF G/COLON TUBE,49465,CPT,361,RC,,,,outpatient,,,291.84,29.18,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,235.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,477.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,242.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,242.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2440,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,232.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,228.36,2440,,facility
SO NEO GSAP 5-50DNA/DNA&RNA,81445,CPT,310,RC,,,,outpatient,,,747.39,74.74,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,597.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,597.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,615.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,597.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1249.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,633.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,597.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,633.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1046.34,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,609.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1249.63,,facility
X-RAY EXAM OF SHOULDER BLADE,73010,CPT,320,RC,,,,outpatient,,,130.94,13.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.39,12.39,12.39,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,448,,facility
ASSAY PHOSPHOHEXOSE ENZYMES,84087,CPT,301,RC,,,,outpatient,,,13.41,1.34,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,22.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.3,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,10.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,10.73,448,,facility
CHEM CAUT OF GRANLTJ TISSUE,17250,CPT,761,RC,,,,outpatient,,,238.44,23.84,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,197.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,401.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,203.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,176.95,3.72,180.67,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,203.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,195.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,192.01,1173,,facility
FLUORESCENT ANTIBODY SCREEN,86255,CPT,302,RC,,,,outpatient,,,15.06,1.51,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.72,10.72,10.72,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,45.41,28.9,1068.67,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,28.9,28.9,28.9,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.72,10.72,10.72,19,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.04,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.05,448,,facility
TREAT TAIL BONE FRACTURE,27200,CPT,450,RC,,,,outpatient,,,280.86,28.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,243.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,493.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,240.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,236.08,1173,,facility
NRV CNDJ TST 3-4 STUDIES,95908,CPT,922,RC,,,,outpatient,,,373.83,37.38,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,206.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,206.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,212.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,206.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,431.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,219.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,206.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,219.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,478,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,210.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,206.65,478,,facility
DNA ANTIBODY NATIVE,86225,CPT,302,RC,,,,outpatient,,,17.18,1.72,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.22,12.22,12.22,16,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,32.21,29.57,46.46,11,percent of total billed charges,,,33.6,,29.57,29.57,29.57,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,29.66,29.57,98.11,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,28.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.22,12.22,12.22,49,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.7,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.74,448,,facility
APPLICATION OF LONG LEG CAST,29345,CPT,450,RC,,,,outpatient,,,319.85,31.99,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,267.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,267.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,275.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,267.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,559.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,283.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,236.5,236.5,236.5,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,267.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,283.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,273.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,267.68,1173,,facility
ASSAY OF THYROID ACTIVITY,84442,CPT,301,RC,,,,outpatient,,,18.48,1.85,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.15,13.15,13.15,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,30.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,31,31,31,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.15,13.15,13.15,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,31.94,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,15.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.78,448,,facility
TERT GENE TARGETED SEQ ALYS,81345,CPT,310,RC,,,,outpatient,,,231.5,23.15,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,185.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,185.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,190.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,185.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,387.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,196.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,185.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,196.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,324.1,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,188.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,185.2,448,,facility
FETAL CONTRACT STRESS TEST,59020,CPT,920,RC,,,,outpatient,,,237.33,23.73,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,193.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,193.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,199.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,193.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,404.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,205.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,193.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,205.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,422,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,197.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,193.49,448,,facility
CT LUMBAR SPINE W/O DYE,72131,CPT,352,RC,,,,outpatient,,,130.94,13.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,93.3,86.83,197.02,50,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,411,411,411,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,378,378,378,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,875,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1050,,,,,,,case rate,NTE Percentage + Reimbursement Rate 85.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,3576.14,2275.73,3867.38,1 through 10,percent of total billed charges,,,33.6,,2275.73,2275.73,2275.73,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,2275.73,2275.73,2296.05,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,94.7,94.14,94.7,35,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1522,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,1522,,facility
KETONE BODYS QUAN,82010,CPT,301,RC,,,,outpatient,,,10.21,1.02,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,7.27,7.27,7.27,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,59.66,59.14,100.5,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,17.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,7.27,7.27,7.27,32,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.66,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,8.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,8.17,448,,facility
CTA ABDOMEN W/CONTRAST,74175,CPT,350,RC,,,,outpatient,,,218.83,21.88,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,875,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1050,,,,,,,case rate,NTE Percentage + Reimbursement Rate 85.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,172.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,2914.56,2914.56,2914.56,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,350.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,177.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,177.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1522,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,171.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,167.87,1522,,facility
TREAT TOE DISLOCATION,28665,CPT,450,RC,,,,outpatient,,,319.85,31.99,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,267.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,267.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,275.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,267.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,559.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,283.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,267.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,283.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,273.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,267.68,1173,,facility
ACYLCARNITINES QUANT,82017,CPT,301,RC,,,,outpatient,,,21.09,2.11,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.01,15.01,15.01,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,279.84,279.84,279.84,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,35.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.01,15.01,15.01,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.45,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,16.87,448,,facility
REMOVE SHOULDER FOREIGN BODY,23330,CPT,450,RC,,,,outpatient,,,1930.94,193.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1628.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3303.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1675.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1675.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1612.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3303.62,,facility
LIPOPROTEIN BLD QUAN PART,83704,CPT,301,RC,,,,outpatient,,,42.74,4.27,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,34.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,34.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,34.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,71.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,36.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,34.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,36.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,68.16,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,34.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,34.19,448,,facility
DNA/RNA SEQUENCING,87153,CPT,306,RC,,,,outpatient,,,144.2,14.42,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,102.61,102.61,102.61,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,115.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,115.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,118.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,385.39,385.39,385.39,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,115.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,241.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,122.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,115.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,122.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,249.24,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,117.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,115.36,448,,facility
X-RAY EXAM OF COLLAR BONE,73000,CPT,320,RC,,,,outpatient,,,108.23,10.82,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,85.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,174.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.95,19.95,20.53,20,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,84.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,83.29,448,,facility
QUANTITATIVE ASSAY DRUG,80299,CPT,301,RC,,,,outpatient,,,23.3,2.33,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,13,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,174.64,174.64,174.64,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,171.6,171.6,171.6,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,374.52,374.52,374.52,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.62,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.64,448,,facility
X-RAY EXAM OF SHOULDER,73020,CPT,320,RC,,,,outpatient,,,108.23,10.82,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,85.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,174.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,84.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,83.29,448,,facility
COL CHROMOTOGRAPHY QUAL/QUAN,82542,CPT,301,RC,,,,outpatient,,,30.11,3.01,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,21.43,21.43,21.43,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,435.07,435.07,435.07,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,24.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,50.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,25.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,21.43,21.43,21.43,15,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,24.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,25.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.16,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,24.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,24.09,448,,facility
X-RAY EXAM OF EYE SOCKETS,70190,CPT,320,RC,,,,outpatient,,,108.23,10.82,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,85.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,174.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,84.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,83.29,448,,facility
N.GONORRHOEAE DNA AMP PROB,87591,CPT,306,RC,,,,outpatient,,,43.86,4.39,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,442,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,50.15,20.65,65.49,11,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,228.48,228.48,228.48,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,37.3,18.48,58.61,60,percent of total billed charges,,,33.6,,37.3,11.76,63.38,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,28.82,11.76,37.3,69,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,42.5,17.5,55.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,23.31,23.31,23.31,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,31.21,31.21,31.21,1 through 10,percent of total billed charges,,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,796,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
RBC LEUKOCYTES REDUCED,P9016,HCPCS,390,RC,,,,outpatient,,,226.03,22.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,169.72,167.88,335.75,32,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,1502.72,1502.72,1502.72,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,184,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,184,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,189.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,1340.71,1239.74,2479.49,1 through 10,percent of total billed charges,,,33.6,,1239.74,788.93,1340.71,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,795.97,795.97,795.97,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,184,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,384.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,195.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,4930.8,4930.8,4930.8,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,136.54,136.54,273.08,30,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,184,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,195.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,107,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,187.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,107,448,,facility
FACTOR INHIBITOR TEST,85335,CPT,305,RC,,,,outpatient,,,16.09,1.61,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.45,11.45,11.45,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,598.85,598.85,598.85,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,26.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.45,11.45,11.45,14,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.81,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.87,448,,facility
MOPATH PROCEDURE LEVEL 5,81404,CPT,310,RC,,,,outpatient,,,343.54,34.35,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,274.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,274.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,283.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,274.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,574.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,291.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,274.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,291.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,480.95,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,280.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,274.83,574.39,,facility
X-RAY EYE FOR FOREIGN BODY,70030,CPT,320,RC,,,,outpatient,,,108.23,10.82,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,85.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,174.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,84.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,83.29,448,,facility
AUTOMATED RETICULOCYTE COUNT,85045,CPT,305,RC,,,,outpatient,,,4.99,0.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.55,3.55,3.55,82,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,112.46,16.13,112.46,40,percent of total billed charges,,,33.6,,16.13,16.13,16.13,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,16.13,16.13,71.57,12,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,8.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,24,23.88,24,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,44.73,44.73,44.73,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.55,3.55,3.55,284,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.63,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,4.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,3.99,448,,facility
X-RAY EXAM UNILAT RIBS/CHEST,71101,CPT,320,RC,,,,outpatient,,,130.94,13.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,23.72,23.72,23.72,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,448,,facility
DRAINAGE OF MOUTH LESION,41005,CPT,450,RC,,,,outpatient,,,290.91,29.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,226.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,226.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,233.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,226.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,473.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,240.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,226.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,240.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,231.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,226.68,1173,,facility
ENZYME CELL ACTIVITY,82657,CPT,301,RC,,,,outpatient,,,27.71,2.77,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.72,19.72,19.72,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,2094.14,2094.14,2094.14,1 through 10,percent of total billed charges,,,33.6,,762.96,762.96,762.96,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,46.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,23.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.72,19.72,19.72,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,23.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,39.01,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,22.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,22.17,448,,facility
DETECT AGENT NOS DNA AMP,87798,CPT,306,RC,,,,outpatient,,,43.86,4.39,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,110.88,110.88,174.24,1 through 10,percent of total billed charges,,,33.6,,244.27,244.27,244.27,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,96.77,32.38,119.79,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,38.9,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
THROMBOPLASTIN TIME PARTIAL,85732,CPT,305,RC,,,,outpatient,,,8.09,0.81,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.75,5.75,5.75,18,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,24.29,15.46,83.95,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,15.46,15.46,15.46,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,13.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.75,5.75,5.75,33,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.97,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,6.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,6.47,448,,facility
TIS TRNFR S/A/L 10.1-30 SQCM,14021,CPT,761,RC,,,,outpatient,,,2171.91,217.19,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1027,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1519,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1974.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1974.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2033.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1974.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,4127.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2093.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1974.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2093.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,2014.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,4127.08,,facility
PSYCL TST EVAL PHYS/QHP 1ST,96130,CPT,918,RC,,,,outpatient,,,373.83,37.38,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,273.22,190.61,358.46,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,206.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,206.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,212.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,206.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,431.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,219.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,206.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,219.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1372,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,210.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,206.65,1372,,professional
X-RAY EXAM OF MASTOIDS,70120,CPT,320,RC,,,,outpatient,,,130.94,13.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,448,,facility
MICROSATELLITE INSTABILITY,81301,CPT,310,RC,,,,outpatient,,,435.7,43.57,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,310.04,310.04,310.04,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,348.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,348.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,359.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,403.87,403.87,403.87,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,348.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,728.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,369.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,348.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,369.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,625.59,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,355.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,348.56,728.49,,facility
FAMILY PSYTX W/PT 50 MIN,90847,CPT,916,RC,,,,outpatient,,,189.89,18.99,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,140.97,140.97,152.83,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,169.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,169.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,174.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,169.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,355.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,180.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,169.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,180.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,173.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,169.87,448,,professional
GENET VIRUS ISOLATE HSV,87255,CPT,306,RC,,,,outpatient,,,42.33,4.23,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,33.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,33.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,34.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,33.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,70.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,33.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,73.17,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,34.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,33.86,448,,facility
R HRT CATH CHD ABNL NT CNJ,93594,CPT,480,RC,,,,outpatient,,,3880.91,388.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2004,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,2759,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,3102.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3102.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3195.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3102.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,6484.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3288.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3102.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3288.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1463,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,3164.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,6484.66,,facility
ASHKENAZI JEWISH ASSOC DIS,81412,CPT,310,RC,,,,outpatient,,,3060.7,306.07,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2448.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2448.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2522.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2448.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,5117.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2595.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2448.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2595.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4284.98,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,2497.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,5117.49,,facility
ASSAY IGA/IGD/IGG/IGM EACH,82784,CPT,301,RC,,,,outpatient,,,11.63,1.16,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,8.27,8.27,8.27,98,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,114.46,59,343.38,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,52.8,30.49,158.4,64,percent of total billed charges,,,33.6,,19.58,19.49,33.6,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,53.09,19.49,195.55,67,percent of total billed charges,,,34.6,,190.57,73.91,336.04,67,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,9.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,19.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,9.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,29,29,50,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,8.27,8.27,8.27,371,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,9.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,9.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.09,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,9.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,9.3,448,,facility
STOOL CULTR AEROBIC BACT EA,87046,CPT,306,RC,,,,outpatient,,,11.8,1.18,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,62.83,62.83,62.83,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,9.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,19.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,9.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.41,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,9.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,9.44,448,,facility
TREAT TOE DISLOCATION,28660,CPT,761,RC,,,,outpatient,,,280.86,28.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,243.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,493.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,240.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,236.08,1173,,facility
TTE W/DOPPLER COMPLETE,93306,CPT,483,RC,,,,outpatient,,,657.04,65.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,481.08,481.08,522.95,571,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,4215.04,4215.04,4215.04,57,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,3885.74,3885.74,3885.74,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,522.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,522.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,538.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,3477.41,2212.9,3477.41,52,percent of total billed charges,,,33.6,,2232.65,2212.9,6058.8,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,2212.9,2212.9,2232.65,40,percent of total billed charges,,,34.6,,2436.82,2436.82,2436.82,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,522.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1092.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,554.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,3293,3293,3293,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,102.2,102.2,107.4,512,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,522.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,554.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,566,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,533.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1092.97,,facility
OBTAINING SCREEN PAP SMEAR,Q0091,HCPCS,923,RC,,,,outpatient,,,35.46,3.55,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,27.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,57.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,29.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,27.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,29.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.57,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,28.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,27.68,448,,facility
DRUG TEST PRSMV CHEM ANLYZR,80307,CPT,301,RC,,,,outpatient,,,77.68,7.77,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,55.27,55.27,55.27,34,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,62.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,62.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,171.87,131.38,223.26,14,percent of total billed charges,,,33.6,,206.45,131.38,223.26,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,131.38,102.04,131.38,13,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,62.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,129.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,65.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,55.27,55.27,55.27,332,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,62.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,65.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,125.7,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,63.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,62.14,448,,facility
ASSAY OF URINE CREATININE,82570,CPT,301,RC,,,,outpatient,,,6.48,0.65,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.61,4.61,4.61,213,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,71.39,41.89,142.78,14,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,37.49,23.86,74.98,60,percent of total billed charges,,,33.6,,37.49,23.85,81.31,18,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,24.07,23.86,47.71,75,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,10.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,60.5,4.61,151,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,14.91,14.91,25.41,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,85.58,85.58,85.58,1 through 10,percent of total billed charges,,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.61,4.61,4.61,636,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.18,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.18,448,,facility
EVACUATION SUBUNGUAL HMTMA,11740,CPT,761,RC,,,,outpatient,,,152.14,15.21,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,131.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,266.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,134.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,134.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,129.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,127.33,1173,,facility
LARGSC W/RMVL FOREIGN BDY(S),31577,CPT,510,RC,,,,outpatient,,,486.31,48.63,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,374.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,374.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,385.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,374.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,782.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,396.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,374.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,396.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,381.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,374.33,1311,,facility
HSV DNA AMP PROBE,87529,CPT,306,RC,,,,outpatient,,,43.86,4.39,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,244.61,244.61,244.61,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
ASSAY OF MERCURY,83825,CPT,301,RC,,,,outpatient,,,20.33,2.03,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,14.46,14.46,14.46,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,33.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,14.46,14.46,14.46,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.12,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,16.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,16.26,448,,facility
INJECTION FOR CHOLANGIOGRAM,47532,CPT,361,RC,,,,outpatient,,,4120.43,412.04,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,3426.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3426.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3529.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3426.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,7161.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3632.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3426.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3632.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10137,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,3495.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,10137,,facility
AQAPRN-4 ANTB FLO CYTMTRY EA,86053,CPT,302,RC,,,,outpatient,,,47.16,4.72,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,33.56,33.56,33.56,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,37.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,37.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,436.8,436.8,686.4,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,440.7,440.7,440.7,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,78.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,39.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,33.56,33.56,33.56,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,39.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.09,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,38.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,21.09,448,,facility
MSH2 GENE KNOWN VARIANTS,81296,CPT,310,RC,,,,outpatient,,,422.16,42.22,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,337.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,337.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,347.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,337.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,705.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,357.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,337.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,357.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,591.03,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,344.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,337.73,705.86,,facility
ASSAY GLUCOSE BLOOD QUANT,82947,CPT,301,RC,,,,outpatient,,,4.91,0.49,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.5,3.5,3.5,64,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,14.08,14.08,14.08,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,49.11,28.9,49.11,12,percent of total billed charges,,,33.6,,28.9,28.9,28.9,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,7.46,7.39,56.98,14,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,8.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,43,43,43,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.5,3.5,3.5,54,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.49,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,4.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,3.93,448,,facility
LYSIS INTRANASAL SYNECHIA,30560,CPT,761,RC,,,,outpatient,,,655.29,65.53,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,516.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,516.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,531.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,516.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1078.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,547.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,516.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,547.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,526.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1311,,facility
TREAT FINGER FRACTURE EACH,26725,CPT,761,RC,,,,outpatient,,,280.86,28.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,243.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,493.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,240.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,236.08,1311,,facility
TREAT KNEE FRACTURE,27532,CPT,761,RC,,,,outpatient,,,3855.04,385.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3131.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3131.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3225.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3131.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,6544.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3319.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3131.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3319.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,3194.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,6544.81,,facility
ASSAY BLD/SERUM CHOLESTEROL,82465,CPT,301,RC,,,,outpatient,,,5.44,0.54,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.87,3.87,3.87,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,20.83,20.83,20.83,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,9.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.87,3.87,3.87,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.4,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,4.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,4.35,448,,facility
ASSAY OF TACROLIMUS,80197,CPT,301,RC,,,,outpatient,,,17.16,1.72,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.21,12.21,12.21,100,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,71.44,70.9,318.86,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,361.57,70.9,361.57,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,28.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.21,12.21,12.21,313,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.68,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.73,448,,facility
NJX AA&/STRD OTHER PN/BRANCH,64450,CPT,361,RC,,,,outpatient,,,823.63,82.36,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,675.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,675.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,695.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,675.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1411.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,716.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,635.65,635.65,635.65,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,675.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,716.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2712,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,689.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,2712,,facility
CARDIOLIPIN ANTIBODY EA IG,86147,CPT,302,RC,,,,outpatient,,,31.81,3.18,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,22.64,22.64,22.64,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,72.86,42.34,163.68,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,50.06,50.06,137.76,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,25.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,53.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,26.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,22.64,22.64,22.64,31,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,25.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,26.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,54.99,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,25.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,25.45,448,,facility
TREAT BIG TOE FRACTURE,28495,CPT,761,RC,,,,outpatient,,,280.86,28.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,243.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,493.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,240.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,236.08,1173,,facility
X-RAY EXAM THORACOLMB 2/> VW,72080,CPT,320,RC,,,,outpatient,,,108.23,10.82,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,85.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,174.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,20.53,20.53,20.53,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,84.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,83.29,448,,facility
PROTON TRMT INTERMEDIATE,77523,CPT,333,RC,,,,outpatient,,,1689.53,168.95,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,1125.4,1047.72,1135.86,35,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2564,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1196.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1196.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1231.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,2060.35,2060.35,2060.35,29,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1196.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,2499.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1267.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,1135.86,1125.4,1135.86,76,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1196.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1267.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,48815,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1219.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,48815,,facility
IMMUNOASSAY QUANT NOS NONAB,83520,CPT,301,RC,,,,outpatient,,,21.59,2.16,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,36,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,66.08,66.08,66.08,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,41.18,24.82,318.38,1 through 10,percent of total billed charges,,,33.6,,37.63,37.63,96.43,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,33.6,23.18,176.4,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,36.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,87,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.22,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.27,448,,facility
ASSAY OF THYROGLOBULIN,84432,CPT,301,RC,,,,outpatient,,,20.08,2.01,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,14.29,14.29,14.29,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,5.9,5.9,33.04,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,5.28,3.36,29.57,1 through 10,percent of total billed charges,,,33.6,,14.58,14.58,18.82,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,14.58,3.36,18.82,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,33.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,14.29,10,14.29,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,34.7,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,16.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,16.06,448,,facility
FUNGUS NES ANTIBODY,86671,CPT,302,RC,,,,outpatient,,,15.31,1.53,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.48,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.25,448,,facility
NUCLEAR ANTIGEN ANTIBODY,86235,CPT,302,RC,,,,outpatient,,,22.41,2.24,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13,12.5,15.95,11,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,54.91,4.37,90.29,43,percent of total billed charges,,,33.6,,4.37,4.37,53.09,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,22.18,4.24,83.33,13,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,37.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.95,13,15.95,54,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.75,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.93,448,,facility
RADEX COMPL AQT ABD SERIES,74022,CPT,320,RC,,,,outpatient,,,130.94,13.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,28.04,28.04,28.04,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,448,,facility
CALR GENE COM VARIANTS,81219,CPT,310,RC,,,,outpatient,,,152.04,15.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,121.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,121.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,125.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,121.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,254.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,128.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,108.19,108.19,108.19,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,121.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,128.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,262.78,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,124.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,121.63,448,,facility
FLUORESCENT ANTIBODY TITER,86256,CPT,302,RC,,,,outpatient,,,15.06,1.51,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.72,10.72,10.72,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.04,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.05,448,,facility
CLTX CALCANEAL FX W/O MNPJ,28400,CPT,450,RC,,,,outpatient,,,280.86,28.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,243.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,493.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,240.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,236.08,1173,,facility
NJX AA&/STRD NTRCOST NRV EA,64421,CPT,361,RC,,,,outpatient,,,1085.56,108.56,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,846.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,846.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,871.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,846.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1769.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,897.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,846.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,897.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2712,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,863.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,2712,,facility
FIBRINOLYTIC PLASMINOGEN,85415,CPT,305,RC,,,,outpatient,,,21.49,2.15,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.29,15.29,15.29,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,35.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.29,15.29,15.29,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,37.14,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.19,448,,facility
PERQ NL/PL LITHOTRP CPLX>2CM,50081,CPT,361,RC,,,,outpatient,,,10971.76,1097.18,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1445,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,2070,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,9059.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9059.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9331.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,9059.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,18935.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,9603.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,9059.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,9603.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10550,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,9241.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,18935.3,,facility
HLTH BHV IVNTJ INDIV 1ST 30,96158,CPT,914,RC,,,,outpatient,,,189.89,18.99,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,156.69,140.97,169.87,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,169.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,169.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,174.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,169.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,355.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,180.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,169.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,180.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,173.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,169.87,448,,professional
INCISION OF TONGUE FOLD,41010,CPT,361,RC,,,,outpatient,,,1816.31,181.63,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,1484.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1484.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1529.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1484.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3103.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1574.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1484.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1574.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3821,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1514.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3821,,facility
MCOLN1 GENE,81290,CPT,310,RC,,,,outpatient,,,49.14,4.91,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,39.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,39.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,40.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,39.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,82.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,41.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,39.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,41.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,68.79,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,40.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,39.31,448,,facility
PLMT URETERAL STENT PRQ,50693,CPT,361,RC,,,,outpatient,,,4151.98,415.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1027,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1519,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,3373.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3373.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3474.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3373.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,7050.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3576.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3373.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3576.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10137,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,3441.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,10137,,facility
REMOVE FOREIGN BODY FROM EYE,65220,CPT,761,RC,,,,outpatient,,,474.54,47.45,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,427.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,427.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,440.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,427.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,893.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,453.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,427.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,453.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,436.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,427.54,893.56,,facility
BRACHYTX ISODOSE PLAN SIMPLE,77316,CPT,333,RC,,,,outpatient,,,440.06,44.01,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,358.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,358.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,369.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,358.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,748.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,379.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,358.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,379.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,48815,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,365.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,358.36,48815,,facility
CT UPPER EXTREMITY W/DYE,73201,CPT,352,RC,,,,outpatient,,,458.03,45.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,403,,,,,,,case rate,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,371,,,,,,,case rate,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,875,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1050,,,,,,,case rate,NTE Percentage + Reimbursement Rate 85.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,333.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,333.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,343.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,333.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,697.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,353.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,126.31,126.31,126.31,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,333.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,353.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1522,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,340.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,333.9,1522,,facility
CLTX ULNAR FX PROX W/O MNPJ,24670,CPT,450,RC,,,,outpatient,,,280.86,28.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,243.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,493.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,240.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,236.08,1173,,facility
AMINO ACIDS QUANT 2-5,82136,CPT,301,RC,,,,outpatient,,,24.51,2.45,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,17.44,17.44,17.44,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,44.41,44.41,44.41,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,40.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,20.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,24.51,24.51,24.51,1 through 10,percent of total billed charges,,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,17.44,17.44,17.44,23,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,20.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.45,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,20,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,19.61,448,,facility
CAR ION CHNNLPATH INC 2 GNS,81414,CPT,310,RC,,,,outpatient,,,731.13,73.11,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,584.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,584.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,602.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,584.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1222.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,619.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,584.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,619.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1263.68,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,596.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1263.68,,facility
ASSAY OF URINE POTASSIUM,84133,CPT,301,RC,,,,outpatient,,,5.91,0.59,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.21,4.21,4.21,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,22.51,22.51,22.71,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,9.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,9.5,9.5,33.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.21,4.21,4.21,20,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.31,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,4.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,4.73,448,,facility
NJX 1 TENDON ORIGIN/INSJ,20551,CPT,761,RC,,,,outpatient,,,352.75,35.28,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,293.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,293.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,302.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,293.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,613.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,311.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,293.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,311.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,299.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,293.77,1173,,facility
Q FEVER ANTIBODY,86638,CPT,302,RC,,,,outpatient,,,15.15,1.52,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.2,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.12,448,,facility
M.AVIUM-INTRA DNA AMP PROB,87561,CPT,306,RC,,,,outpatient,,,43.86,4.39,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
IDH2 COMMON VARIANTS,81121,CPT,310,RC,,,,outpatient,,,369.74,36.97,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,295.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,295.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,304.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,137.3,137.3,137.3,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,295.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,618.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,313.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,295.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,313.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,517.63,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,301.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,295.79,618.2,,facility
CLTX DST RDL FX/EPHYS SEP W/,25605,CPT,761,RC,,,,outpatient,,,1914.16,191.42,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1027,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1519,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1585.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3216.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1631.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1631.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,1569.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3216.38,,facility
GIARDIA LAMBLIA ANTIBODY,86674,CPT,302,RC,,,,outpatient,,,18.4,1.84,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,30.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,31.8,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,15.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.72,448,,facility
MUMPS ANTIBODY,86735,CPT,302,RC,,,,outpatient,,,16.31,1.63,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.61,11.61,11.61,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,22.18,22.18,85.01,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,68.61,68.61,68.61,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,44,44,44,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.61,11.61,11.61,15,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.19,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.05,448,,facility
"PLT, APH/PHER, L/R, CMV-NEG",P9055,HCPCS,390,RC,,,,outpatient,,,313.51,31.35,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,249.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,249.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,256.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,249.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,520.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,264.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,249.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,264.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,107,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,254.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,107,520.95,,facility
MONONUCLEAR CELL ANTIGEN,86356,CPT,302,RC,,,,outpatient,,,33.48,3.35,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,23.82,23.82,23.82,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,138.06,138.06,552.24,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,464.64,464.64,464.64,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,26.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,55.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,28.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,23.82,23.82,23.82,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,26.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,28.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,57.86,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,27.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,26.78,448,,facility
HELMINTH ANTIBODY,86682,CPT,302,RC,,,,outpatient,,,16.26,1.63,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.57,11.57,11.57,36,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,56.78,56.78,66.44,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.57,11.57,11.57,12,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.11,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.01,448,,facility
"INJ. PEMETREXED, 10 MG",J9304,HCPCS,636,RC,,,,outpatient,,,66.19,6.62,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,7.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,10430.43,9236.59,10523.56,1348,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,7.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,16.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,7.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,113.31,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,8.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,7.99,448,,facility
LYME DISEASE ANTIBODY,86618,CPT,302,RC,,,,outpatient,,,21.29,2.13,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,35.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.15,15.15,15.15,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.79,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.03,448,,facility
"INJ, STIMUFEND, 0.5 MG",Q5127,HCPCS,636,RC,,,,outpatient,,,419.24,41.92,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,143.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,143.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,147.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,143.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,300.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,152.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,143.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,152.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,641.37,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,146.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,143.67,641.37,,facility
CNS DNA AMP PROBE TYPE 12-25,87483,CPT,306,RC,,,,outpatient,,,520.98,52.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,416.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,416.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,429.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,416.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,871.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,441.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,416.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,441.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,900.46,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,425.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,416.78,900.46,,facility
X-RAY EXAM OF ARM INFANT,73092,CPT,320,RC,,,,outpatient,,,130.94,13.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.14,19.14,19.14,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,448,,facility
APPLICATION LONG LEG SPLINT,29505,CPT,450,RC,,,,outpatient,,,187.66,18.77,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,155.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,155.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,160.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,155.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,325.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,164.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,155.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,164.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,158.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,155.52,448,,facility
HLA II TYPING 1 LOCUS LR,81376,CPT,310,RC,,,,outpatient,,,152.78,15.28,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,122.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,122.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,125.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,122.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,255.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,129.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,122.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,129.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,264.06,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,124.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,122.22,448,,facility
DX LMBR SPI PNXR,62270,CPT,761,RC,,,,outpatient,,,823.63,82.36,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,607.62,586.32,616.7,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,675.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,675.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,695.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,925.01,925.01,925.01,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,675.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1411.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,716.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,616.7,616.7,925.05,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,675.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,716.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,689.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1411.94,,facility
AMINO ACIDS QUAN 6 OR MORE,82139,CPT,301,RC,,,,outpatient,,,21.09,2.11,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.01,12,15.01,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,230.18,110.21,262.42,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,35.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,164.01,164.01,164.01,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.01,12,15.01,16,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.45,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,16.87,448,,facility
INSERT TEMP BLADDER CATH,51702,CPT,761,RC,,,,outpatient,,,152.14,15.21,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,131.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,266.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,134.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,134.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,129.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,127.33,1173,,facility
DETECT AGENT NOS DNA QUANT,87799,CPT,306,RC,,,,outpatient,,,53.55,5.36,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,38.11,38.11,38.11,39,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,44.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,200.64,91.44,597.79,1 through 10,percent of total billed charges,,,33.6,,203.95,203.95,203.95,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,231.27,203.95,231.27,11,percent of total billed charges,,,34.6,,220.34,220.34,231.27,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,89.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,45.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,38.11,38.11,38.11,221,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,45.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,92.54,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,43.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,42.84,448,,facility
IMMUNFIX E-PHORSIS/URINE/CSF,86335,CPT,302,RC,,,,outpatient,,,36.69,3.67,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,26.11,26.11,26.11,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,25.76,25.76,25.76,1 through 10,percent of total billed charges,,,34.6,,56.99,56.99,56.99,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,29.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,61.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,31.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,26.11,26.11,26.11,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,29.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,31.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,63.4,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,29.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,29.35,448,,facility
REMOVAL OF FOOT FOREIGN BODY,28193,CPT,450,RC,,,,outpatient,,,1930.94,193.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1268,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1793,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1628.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3303.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1675.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1675.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1612.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3303.62,,facility
DRUG ASSAY CAFFEINE,80155,CPT,301,RC,,,,outpatient,,,48.21,4.82,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,39.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,38.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,80.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,40.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,38.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,40.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,67.5,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,39.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,38.57,448,,facility
M.TUBERCULO DNA AMP PROBE,87556,CPT,306,RC,,,,outpatient,,,52.1,5.21,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,41.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,41.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,41.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,87.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,44.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,41.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,44.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,42.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,41.68,448,,facility
FETAL NON-STRESS TEST,59025,CPT,920,RC,,,,outpatient,,,237.33,23.73,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,176.51,176.51,193.49,488,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,38.76,38.76,38.76,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,193.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,193.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,199.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,187.86,110.54,187.86,1 through 10,percent of total billed charges,,,33.6,,173.71,110.54,187.86,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,110.54,96.95,110.54,11,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,193.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,404.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,205.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,164.5,164.5,329,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,69.09,69.09,69.09,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.44,16.44,16.92,373,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,193.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,205.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,422,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,197.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,193.49,448,,facility
INJ TRASTUZUMAB EXCL BIOSIMI,J9355,HCPCS,636,RC,,,,outpatient,,,97.6,9.76,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,70.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,70.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,72.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,70.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,146.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,74.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,70.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,74.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,165.66,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,71.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,70.24,448,,facility
"RBC, L/R, CMV-NEG, IRRAD",P9058,HCPCS,390,RC,,,,outpatient,,,302.33,30.23,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,248.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,248.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,255.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,248.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,518.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,263.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,248.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,263.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,107,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,253.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,107,518.7,,facility
PSYTX CRISIS INITIAL 60 MIN,90839,CPT,900,RC,,,,outpatient,,,189.89,18.99,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,169.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,169.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,174.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,169.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,355.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,180.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,169.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,180.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1372,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,173.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,169.87,1372,,professional
IADNA-DNA/RNA PROBE TQ 12-25,87507,CPT,306,RC,,,,outpatient,,,520.98,52.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,416.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,416.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,429.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,416.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,871.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,441.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,1150,1150,1150,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,416.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,441.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,900.46,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,425.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,416.78,900.46,,facility
HDR RDNCL NTRSTL/ICAV BRCHTX,77770,CPT,342,RC,,,,outpatient,,,853.91,85.39,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,666.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,666.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,686.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,666.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1393.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,706.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,666.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,706.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1945,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,679.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1945,,facility
APPLICATION LONG ARM SPLINT,29105,CPT,761,RC,,,,outpatient,,,187.66,18.77,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,155.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,155.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,160.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,155.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,325.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,164.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,155.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,164.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,158.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,155.52,448,,facility
HEMOGLOBIN CHROMOTOGRAPHY,83021,CPT,301,RC,,,,outpatient,,,22.58,2.26,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.06,16.06,16.06,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,37.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,58.38,58.38,58.38,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.06,16.06,16.06,16,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,39.01,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.06,448,,facility
SMALL BOWEL ENDOSCOPY,44364,CPT,750,RC,,,,outpatient,,,2266.24,226.62,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,1836.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1836.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1891.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1836.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3838.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1946.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1836.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1946.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3821,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1873.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3838.31,,facility
GROWTH STIMULATION GENE 2,83006,CPT,301,RC,,,,outpatient,,,94.5,9.45,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,77.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,75.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,158,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,80.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,75.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,80.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,132.3,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,77.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,75.6,448,,facility
IMAGE CATH FLUID PERI/RETRO,49406,CPT,361,RC,,,,outpatient,,,1930.94,193.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1628.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3303.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1675.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1675.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3821,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1612.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3821,,facility
TREAT LOWER LEG FRACTURE,27824,CPT,450,RC,,,,outpatient,,,280.86,28.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,243.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,493.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,240.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,236.08,1173,,facility
BODY FLUID CELL COUNT,89051,CPT,309,RC,,,,outpatient,,,7,0.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,503.78,376.99,592.42,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,11.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.98,4.98,4.98,47,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.9,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.6,448,,facility
REPLACE DUOD/JEJ TUBE PERC,49451,CPT,361,RC,,,,outpatient,,,1079.61,107.96,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,868.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,868.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,894.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,868.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1814.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,920.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,868.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,920.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3821,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,885.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3821,,facility
R HRT CORONARY ARTERY ANGIO,93456,CPT,480,RC,,,,outpatient,,,3880.91,388.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2004,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,2759,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,3102.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3102.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3195.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3102.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,6484.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3288.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3102.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3288.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1463,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,3164.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,1463,6484.66,,facility
ELECTROPHORETIC TEST,82664,CPT,301,RC,,,,outpatient,,,76.88,7.69,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,61.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,61.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,63.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,61.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,128.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,65.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,61.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,65.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,107.63,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,62.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,61.5,448,,facility
DEHYDROEPIANDROSTERONE,82627,CPT,301,RC,,,,outpatient,,,27.79,2.78,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.77,19.77,19.77,24,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,44.25,44.25,44.25,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,39.6,39.6,142.03,1 through 10,percent of total billed charges,,,33.6,,25.2,25.2,25.2,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,25.2,25.2,90.38,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,46.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,23.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.77,19.77,19.77,42,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,23.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,48.04,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,22.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,22.23,448,,facility
UROGRAPHY RTRGR +-KUB,74420,CPT,320,RC,,,,outpatient,,,458.03,45.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,333.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,333.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,343.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,333.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,697.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,353.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,333.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,353.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,340.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,333.9,697.85,,facility
APPL FINGER SPLINT DYNAMIC,29131,CPT,430,RC,,,,outpatient,,,72.85,7.29,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,80,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,56.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,56.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,58.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,56.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,118,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,59.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,56.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,59.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,422,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,57.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,56.46,448,,facility
SYPHILIS TEST NON-TREP QUAL,86592,CPT,302,RC,,,,outpatient,,,5.34,0.53,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.8,3.8,3.8,262,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,28.8,3.16,28.8,20,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,26.55,26.4,79.65,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,28.8,28.8,28.8,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,23.76,15.12,23.76,39,percent of total billed charges,,,33.6,,15.17,15.12,45.36,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,15.12,15.12,15.17,34,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,8.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,22.38,22.38,22.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.8,3.8,3.8,282,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.22,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,4.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,4.27,448,,facility
ASSAY CARBOXYHB QUANT,82375,CPT,301,RC,,,,outpatient,,,15.4,1.54,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.96,10.96,10.96,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.62,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.32,448,,facility
HEPATITIS B DNA QUANT,87517,CPT,306,RC,,,,outpatient,,,53.55,5.36,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,38.11,38.11,38.11,15,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,44.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,95.04,95.04,355.34,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,60.48,60.48,95.09,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,89.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,45.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,90,90,90,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,38.11,38.11,38.11,25,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,45.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,92.54,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,43.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,42.84,448,,facility
TREATMENT OF THIGH FRACTURE,27501,CPT,761,RC,,,,outpatient,,,280.86,28.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,243.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,493.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,240.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,236.08,1311,,facility
APPL RIGID TOT CNTC LEG CAST,29445,CPT,761,RC,,,,outpatient,,,319.85,31.99,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,267.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,267.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,275.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,267.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,559.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,283.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,267.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,283.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,273.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,267.68,559.45,,facility
PHOSPHOLIPID PLTLT NEUTRALIZ,85597,CPT,305,RC,,,,outpatient,,,22.48,2.25,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,37.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.98,448,,facility
DSTRJ NULYT AGT GNCLR NRV,64624,CPT,361,RC,,,,outpatient,,,2299.54,229.95,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,1868.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1868.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1924.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1868.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3905.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1981,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1868.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1981,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9389,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1906.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,9389,,facility
CLTX HUM EPCNDYLR FX W/MNPJ,24565,CPT,761,RC,,,,outpatient,,,1914.16,191.42,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1585.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3216.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1631.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1631.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,1569.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3216.38,,facility
ASSAY OF GONADOTROPIN (FSH),83001,CPT,301,RC,,,,outpatient,,,23.23,2.32,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.53,16.53,16.53,63,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,146.91,146.91,146.91,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,35.38,22.51,35.38,22,percent of total billed charges,,,33.6,,35.38,35.38,131.47,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,22.51,22.51,83.66,27,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,33.5,33.5,33.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,14.07,14.07,14.07,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.53,16.53,16.53,116,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,40.15,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.58,448,,facility
RADIATION TX DELIVERY LVL 3,77412,CPT,333,RC,,,,outpatient,,,320.08,32.01,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,458.96,458.96,458.96,15,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,984.96,984.96,6322.56,16,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,528.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,528.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,544.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,541.97,541.97,3319.34,24,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,541.97,521.72,541.97,32,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,528.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1105.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,560.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,497.57,370.62,497.57,196,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,528.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,560.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,48815,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,539.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,48815,,facility
BRACHYTX ISODOSE COMPLEX,77318,CPT,333,RC,,,,outpatient,,,440.06,44.01,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,358.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,358.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,369.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,358.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,748.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,379.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,358.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,379.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,48815,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,365.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,358.36,48815,,facility
CHEMO IV INFUSION ADDL HR,96415,CPT,335,RC,,,,outpatient,,,83.9,8.39,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,62.45,58.46,175.39,429,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,532.48,490.88,1597.44,87,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,1472.64,1472.64,1472.64,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,68.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,68.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,70.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,878.59,282.05,1317.89,86,percent of total billed charges,,,33.6,,279.55,279.55,838.66,33,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,279.55,279.55,559.1,50,percent of total billed charges,,,34.6,,316.99,316.99,316.99,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,68.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,144.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,73.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,416,416,416,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,174.72,174.72,174.72,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,64.84,63.38,190.14,237,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,68.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,73.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1603,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,70.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,68.91,1603,,facility
INTMD RPR FACE/MM 7.6-12.5CM,12054,CPT,761,RC,,,,outpatient,,,474.9,47.49,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,400.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,813.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,412.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,412.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,396.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,389.05,1311,,facility
ASSAY OF FREE THYROXINE,84439,CPT,301,RC,,,,outpatient,,,11.28,1.13,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,8.02,8.02,8.02,335,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,53.1,53.1,309.16,13,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,47.52,30.24,276.67,112,percent of total billed charges,,,33.6,,47.52,30.24,276.67,25,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,30.24,30.24,176.06,119,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,9.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,18.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,9.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,45.13,45,262,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,18.9,18.9,18.9,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,8.02,8.02,8.02,954,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,9.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,9.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.48,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,9.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,9.02,448,,facility
PROTEIN WESTERN BLOT TEST,84182,CPT,301,RC,,,,outpatient,,,36.51,3.65,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,217.54,217.54,217.54,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,29.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,61.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,30.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,25.98,25.98,25.98,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,29.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,30.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,51.12,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,29.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,29.21,448,,facility
TIS TRNFR S/A/L 10 SQ CM/<,14020,CPT,761,RC,,,,outpatient,,,2171.91,217.19,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1027,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1519,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1974.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1974.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2033.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1974.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,4127.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2093.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1974.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2093.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,2014.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,4127.08,,facility
CHROMOGENIC SUBSTRATE ASSAY,85130,CPT,305,RC,,,,outpatient,,,14.86,1.49,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.58,10.58,10.58,11,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,571.12,571.12,571.12,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,277.2,277.2,277.2,1 through 10,percent of total billed charges,,,33.6,,176.4,176.4,176.4,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,24.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.58,10.58,10.58,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.69,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.89,448,,facility
ASSAY OF DIBUCAINE NUMBER,82638,CPT,301,RC,,,,outpatient,,,15.31,1.53,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.46,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.25,448,,facility
ENCEPHALITIS CALIFORN ANTBDY,86651,CPT,302,RC,,,,outpatient,,,16.49,1.65,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.49,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.19,448,,facility
DSTRJ MAL LES T/A/L 2.1-3.0,17263,CPT,761,RC,,,,outpatient,,,238.44,23.84,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,197.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,401.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,203.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,203.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,195.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,192.01,1173,,facility
INTMD RPR N-HF/GENIT2.6-7.5,12042,CPT,510,RC,,,,outpatient,,,474.9,47.49,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,164.09,164.09,175.27,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,400.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,813.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,412.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,355.79,10.28,355.79,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,412.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,396.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,389.05,1173,,facility
BORDETELLA ANTIBODY,86615,CPT,302,RC,,,,outpatient,,,16.49,1.65,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.73,11.73,11.73,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.49,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.19,448,,facility
RPR FE/E/EN/L/M 12.6-20.0 CM,12016,CPT,761,RC,,,,outpatient,,,474.9,47.49,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,400.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,813.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,412.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,412.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,396.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,389.05,1311,,facility
REMOVE FOREIGN BODY LARYNX,31511,CPT,450,RC,,,,outpatient,,,235.91,23.59,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,191.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,191.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,196.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,191.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,399.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,202.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,191.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,202.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,194.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,191.04,1311,,facility
EXAM SYNOVIAL FLUID CRYSTALS,89060,CPT,309,RC,,,,outpatient,,,9.16,0.92,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,90.38,90.38,90.38,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,90.38,90.38,90.38,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,7.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,15.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,7.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,6.52,6.52,6.52,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,7.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,7.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.45,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,7.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,7.33,448,,facility
APPL MLTLAY CMPRN SYS UP ARM,29584,CPT,761,RC,,,,outpatient,,,187.66,18.77,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,155.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,155.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,160.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,155.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,325.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,164.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,155.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,164.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,158.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,155.52,448,,facility
ASSAY OF OXALATE,83945,CPT,301,RC,,,,outpatient,,,18.06,1.81,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,30.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.85,12.85,12.85,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.81,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.45,448,,facility
TREATMENT OF THIGH FRACTURE,27500,CPT,450,RC,,,,outpatient,,,280.86,28.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,243.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,493.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,240.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,236.08,1173,,facility
RPR S/N/AX/GEN/TRNK2.6-7.5CM,12002,CPT,761,RC,,,,outpatient,,,238.44,23.84,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,197.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,401.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,203.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,203.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,195.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,192.01,448,,facility
ASSAY OF 5-HIAA,83497,CPT,301,RC,,,,outpatient,,,16.13,1.61,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,26.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.86,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.9,448,,facility
EXC TR-EXT MAL+MARG 0.6-1 CM,11601,CPT,761,RC,,,,outpatient,,,837.95,83.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,677.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,677.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,698.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,677.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1416.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,718.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,677.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,718.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,691.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1416.43,,facility
SO/HL 51/>GSAP DNA/DNA&RNA,81455,CPT,310,RC,,,,outpatient,,,3649.5,364.95,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2919.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2919.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3007.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2919.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,6101.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3094.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2919.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3094.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5109.3,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,2977.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,6101.96,,facility
X-RAY EXAM OF FOREARM,73090,CPT,320,RC,,,,outpatient,,,108.23,10.82,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,85.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,174.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,17.52,17.52,18.03,76,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,84.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,83.29,448,,facility
I&D PILONIDAL CYST COMP,10081,CPT,761,RC,,,,outpatient,,,837.95,83.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,677.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,677.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,698.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,677.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1416.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,718.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,677.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,718.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,691.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1416.43,,facility
ASSAY OF ANDROSTENEDIONE,82157,CPT,301,RC,,,,outpatient,,,36.6,3.66,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,26.04,26.04,26.04,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,29.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,61.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,31.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,26.04,0.22,26.04,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,29.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,31.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,63.25,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,29.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,29.28,448,,facility
ASSAY OF SELENIUM,84255,CPT,301,RC,,,,outpatient,,,31.91,3.19,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,22.71,22.71,22.71,14,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,46.99,46.99,46.99,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,25.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,53.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,27.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,22.71,22.71,22.71,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,25.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,27.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,55.16,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,26.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,25.53,448,,facility
CLTX RDL SHFT FX W/O MNPJ,25500,CPT,761,RC,,,,outpatient,,,280.86,28.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,243.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,493.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,240.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,236.08,1173,,facility
TESTOSTERONE BIOAVAILABLE,84410,CPT,301,RC,,,,outpatient,,,64.1,6.41,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,51.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,51.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,52.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,51.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,107.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,54.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,51.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,54.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,110.81,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,52.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,51.28,448,,facility
PLATELETS PHERESIS PATH REDU,P9073,HCPCS,390,RC,,,,outpatient,,,689.1,68.91,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,541.71,541.71,541.71,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,604.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,604.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,622.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,604.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1263.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,640.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,604.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,640.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,107,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,616.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,107,1263.3,,facility
UNLISTED PX TRACHEA BRONCHI,31899,CPT,510,RC,,,,outpatient,,,235.91,23.59,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,191.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,191.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,196.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,191.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,399.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,202.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,191.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,202.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,194.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,191.04,1173,,facility
X-RAY EXAM OF JAW JOINTS,70330,CPT,320,RC,,,,outpatient,,,108.23,10.82,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,85.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,174.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,84.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,83.29,448,,facility
PSYCL/NRPSYC TECH 1ST,96138,CPT,918,RC,,,,outpatient,,,474.54,47.45,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,391.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,391.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,403.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,391.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,819.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,415.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,391.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,415.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1372,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,399.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,391.99,1372,,professional
JAK2 GENE,81270,CPT,310,RC,,,,outpatient,,,114.58,11.46,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,91.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,91.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,94.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,297.36,297.36,297.36,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,91.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,191.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,97.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,175,175,175,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,81.53,81.53,81.53,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,91.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,97.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,198.05,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,93.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,91.66,448,,facility
EXTREMITY STUDY,93970,CPT,921,RC,,,,outpatient,,,291.84,29.18,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,235.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,477.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,242.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,242.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1227,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,232.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,228.36,1227,,facility
HBB GENE KNOWN FAM VARIANT,81362,CPT,310,RC,,,,outpatient,,,469.06,46.91,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,375.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,375.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,386.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,375.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,784.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,397.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,375.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,397.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,656.69,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,382.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,375.25,784.27,,facility
PARVOVIRUS ANTIBODY,86747,CPT,302,RC,,,,outpatient,,,18.79,1.88,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,31.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.48,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,15.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,15.03,448,,facility
DIAGNOSTIC COLONOSCOPY,45378,CPT,750,RC,,,,outpatient,,,1088.51,108.85,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,799.94,399.97,837.43,14,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,890.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,890.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,916.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,2185.27,1269.22,2185.29,1 through 10,percent of total billed charges,,,33.6,,1635.31,1635.31,1635.31,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,1635.31,1269.22,1635.31,15,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,890.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1860.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,943.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,811.89,0.12,837.43,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,890.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,943.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3821,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,907.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3821,,facility
NK CELLS TOTAL COUNT,86357,CPT,302,RC,,,,outpatient,,,47.16,4.72,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,33.56,33.56,33.56,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,60.77,60.77,60.77,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,37.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,37.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,27.98,27.98,27.98,1 through 10,percent of total billed charges,,,33.6,,33.56,33.56,33.56,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,537.59,537.59,537.59,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,78.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,39.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,33.56,33.56,33.56,25,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,39.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,81.52,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,38.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,37.73,448,,facility
WEST NILE VIRUS ANTIBODY,86789,CPT,302,RC,,,,outpatient,,,17.99,1.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,63.5,63.5,63.5,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,30.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.8,12.8,12.8,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,31.1,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.39,448,,facility
TREATMENT OF MOUTH LESION,40820,CPT,761,RC,,,,outpatient,,,3834.53,383.45,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3173.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3173.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3268.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3173.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,6631.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3363.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3173.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3363.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,3236.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,6631.76,,facility
BRCA2 GENE FULL SEQ ALYS,81216,CPT,310,RC,,,,outpatient,,,231.4,23.14,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,185.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,185.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,190.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,185.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,386.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,196.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,185.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,196.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,323.96,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,188.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,185.12,448,,facility
X-RAY EXAM OF SINUSES,70210,CPT,320,RC,,,,outpatient,,,108.23,10.82,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,85.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,174.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,84.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,83.29,448,,facility
REMOVE HIP FOREIGN BODY,27087,CPT,450,RC,,,,outpatient,,,3855.04,385.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1027,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1519,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3131.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3131.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3225.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3131.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,6544.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3319.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3131.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3319.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3194.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,6544.81,,facility
CLOT FACTOR VII PROCONVERTIN,85230,CPT,305,RC,,,,outpatient,,,22.38,2.24,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.92,15.92,15.92,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,37.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.92,15.92,15.92,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.68,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.9,448,,facility
CT ANGIO LWR EXTR W/O&W/DYE,73706,CPT,352,RC,,,,outpatient,,,218.83,21.88,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,875,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1050,,,,,,,case rate,NTE Percentage + Reimbursement Rate 85.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,172.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,350.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,177.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,143,143,143,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,177.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1522,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,171.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,167.87,1522,,facility
X-RAY EXAM HIPS BI 5/> VIEWS,73523,CPT,320,RC,,,,outpatient,,,130.94,13.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,448,,facility
VIRUS INOCULATE TISSUE ADDL,87253,CPT,306,RC,,,,outpatient,,,25.25,2.53,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,20.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,42.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,21.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,20.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,21.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,43.65,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,20.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,20.2,448,,facility
NJX AA&/STRD GNCLR NRV BRNCH,64454,CPT,361,RC,,,,outpatient,,,823.63,82.36,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,675.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,675.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,695.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,675.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1411.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,716.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,675.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,716.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2712,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,689.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,2712,,facility
BLOOD SPLIT UNIT,P9011,HCPCS,390,RC,,,,outpatient,,,186.34,18.63,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,141.8,130.8,155.08,21,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,558.72,558.72,558.72,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,155.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,155.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,159.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,155.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,324.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,164.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,155.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,164.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,107,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,158.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,107,448,,facility
HEAVY METAL QUAN EACH NES,83018,CPT,301,RC,,,,outpatient,,,27.45,2.75,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,21.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,45.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,23.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,21.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,23.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,47.46,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,22.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,21.96,448,,facility
INJ CLADRIBINE PER 1 MG,J9065,HCPCS,636,RC,,,,outpatient,,,16.59,1.66,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,8.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,17.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.23,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,8.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,8.19,448,,facility
INTRACRANIAL LIMITED STUDY,93888,CPT,921,RC,,,,outpatient,,,130.94,13.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1227,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,1227,,facility
CLOT INHIBIT PROT S FREE,85306,CPT,305,RC,,,,outpatient,,,19.15,1.92,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.63,13.63,13.63,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,29.04,18.48,29.04,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,81.65,81.65,81.65,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,32.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.63,13.63,13.63,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,33.11,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,15.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,15.32,448,,facility
DRUG ASSAY ADALIMUMAB,80145,CPT,301,RC,,,,outpatient,,,48.21,4.82,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,39.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,38.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,80.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,40.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,34.31,34.31,34.31,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,38.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,40.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,67.5,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,39.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,38.57,448,,facility
NJX AA&/STRD BRCH PLXS IMG,64415,CPT,361,RC,,,,outpatient,,,1085.56,108.56,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,846.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,846.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,871.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,846.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1769.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,897.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,846.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,897.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2712,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,863.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,2712,,facility
ASSMT & CARE PLN PT COG IMP,99483,CPT,510,RC,,,,outpatient,,,106.16,10.62,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,89.68,81.16,97.23,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,97.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,97.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,97.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,203.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,97.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,99.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,97.23,448,,facility
UNLISTED PROCEDURE PANCREAS,48999,CPT,750,RC,,,,outpatient,,,837.95,83.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,338.86,338.86,338.86,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,677.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,677.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,698.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,677.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1416.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,718.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,677.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,718.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2712,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,691.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,2712,,facility
CASIRIVI AND IMDEVI INJ,M0243,HCPCS,771,RC,,,,outpatient,,,563.13,56.31,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 103.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment.",,,,0,other,"Payer contract is 103.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment. + No services performed during 15-month lookback period",,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment. + No services performed during 15-month lookback period",,,"Payer contract is 209.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment.",,,,0,other,"Payer contract is 209.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment. + No services performed during 15-month lookback period",,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment. + No services performed during 15-month lookback period",,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,232,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,"Payer contract is 102.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment.",,,,0,other,"Payer contract is 102.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment. + No services performed during 15-month lookback period",232,448,,facility
MASS SPECTROMETRY QUAL/QUAN,83789,CPT,301,RC,,,,outpatient,,,30.14,3.01,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,24.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,50.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,25.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,24.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,25.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.19,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,24.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,24.11,448,,facility
APPL SHORT ARM SPLINT DYN,29126,CPT,420,RC,,,,outpatient,,,152.14,15.21,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,80,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,131.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,266.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,134.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,134.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,422,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,129.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,80,448,,facility
VIRUS ANTIBODY NOS,86790,CPT,302,RC,,,,outpatient,,,16.1,1.61,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.46,11.46,11.46,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,107.86,20.06,169.49,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,116.52,40.29,122.3,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,26.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.46,11.46,11.46,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.88,448,,facility
PHOTOPHERESIS,36522,CPT,361,RC,,,,outpatient,,,5511.68,551.17,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,4168.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4168.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4293.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4168.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,8712.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4418.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,9528.12,4764.06,9528.12,12,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4168.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4418.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10550,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,4251.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,10550,,facility
SC STD AGAR DILUTION PER AGT,87181,CPT,306,RC,,,,outpatient,,,5.94,0.59,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,9.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.26,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,4.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,4.75,448,,facility
NDL EMG SINGLE FIBER ELTRD,95872,CPT,922,RC,,,,outpatient,,,186.04,18.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,206.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,206.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,212.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,206.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,431.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,219.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,206.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,219.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,478,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,210.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,206.65,478,,facility
CYTOGENETICS 100-300,88275,CPT,311,RC,,,,outpatient,,,63.99,6.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,45.53,45.53,45.53,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,51.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,51.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,52.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,1828.51,1828.51,1828.51,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,401.18,401.18,401.18,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,51.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,106.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,54.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,45.53,45.53,45.53,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,51.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,54.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,89.58,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,52.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,51.19,448,,facility
APPL FINGER SPLINT STATIC,29130,CPT,420,RC,,,,outpatient,,,152.14,15.21,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,80,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,131.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,266.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,134.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,134.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,422,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,129.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,80,448,,facility
ALYS CPLX CN NPGT PRGRMG,95977,CPT,920,RC,,,,outpatient,,,115.29,11.53,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,90.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,90.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,93.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,90.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,190.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,96.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,90.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,96.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,422,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,92.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,90.99,448,,facility
EXC H-F-NK-SP B9+MARG 2.1-3,11423,CPT,761,RC,,,,outpatient,,,1930.94,193.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1628.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3303.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1675.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,1442.85,1442.85,1442.85,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1675.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,1612.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3303.62,,facility
COMPATIBILITY TEST ELECTRIC,86923,CPT,302,RC,,,,outpatient,,,203.43,20.34,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,150.35,150.35,269.89,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,205.91,205.91,617.73,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,167.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,184.27,184.27,398.56,1 through 10,percent of total billed charges,,,33.6,,117.26,117.26,199.28,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,236.62,236.62,236.62,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,340.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,172.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,172.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,226.07,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,166.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,163.06,448,,facility
ASSAY OF CAROTENE,82380,CPT,301,RC,,,,outpatient,,,11.53,1.15,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,9.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,19.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,9.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,9.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,9.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.93,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,9.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,9.22,448,,facility
X-RAY EXAM OF EYE SOCKETS,70200,CPT,320,RC,,,,outpatient,,,130.94,13.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,800,800,800,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,448,,facility
HISTOPLASMA ANTIBODY,86698,CPT,302,RC,,,,outpatient,,,17.24,1.72,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.27,12.27,12.27,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,28.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.27,12.27,12.27,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.79,448,,facility
TX GASTRO INTUB W/ASP,43753,CPT,750,RC,,,,outpatient,,,373.83,37.38,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,206.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,206.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,212.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,206.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,431.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,219.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,206.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,219.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2440,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,210.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,206.65,2440,,facility
PROTEIN E-PHORESIS SERUM,84165,CPT,301,RC,,,,outpatient,,,13.43,1.34,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9.55,9.55,9.55,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,287.76,46.46,287.76,1 through 10,percent of total billed charges,,,33.6,,29.57,29.57,29.57,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,29.92,29.57,184.76,1 through 10,percent of total billed charges,,,34.6,,197.83,197.83,207.64,11,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,22.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9.55,9.55,9.55,33,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,23.21,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,10.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,10.74,448,,facility
UNLISTED PX URINARY SYSTEM,53899,CPT,761,RC,,,,outpatient,,,294.35,29.44,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,239.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,239.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,246.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,239.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,499.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,253.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,239.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,253.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,243.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,239.12,1173,,facility
BIOPSY OF EXTERNAL EAR,69100,CPT,510,RC,,,,outpatient,,,290.91,29.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,226.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,226.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,233.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,226.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,473.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,240.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,226.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,240.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,231.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,226.68,473.76,,facility
X-RAY EXAM HIPS BI 3-4 VIEWS,73522,CPT,320,RC,,,,outpatient,,,130.94,13.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,448,,facility
STREP A AG IA,87430,CPT,306,RC,,,,outpatient,,,21.01,2.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,14.95,14.95,14.95,49,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,62.72,62.72,62.72,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,12.98,12.98,12.98,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,51.74,32.93,55.96,13,percent of total billed charges,,,33.6,,32.93,32.93,51.74,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,32.93,25.43,32.93,15,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,35.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,20.58,20.58,20.58,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,14.95,14.95,14.95,106,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.42,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,16.81,448,,facility
BRONCHOSCOPY W/FB REMOVAL,31635,CPT,761,RC,,,,outpatient,,,2021.43,202.14,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1703.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1703.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1754.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1703.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3560.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1805.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1703.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1805.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,1737.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3560.23,,facility
ELECTROCARDIOGRAM TRACING,93005,CPT,730,RC,,,,outpatient,,,72.85,7.29,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,52.12,52.08,56.46,233,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,340.48,340.48,340.48,88,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,313.88,313.88,313.88,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,56.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,56.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,58.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,280.9,178.75,303.78,191,percent of total billed charges,,,33.6,,180.35,178.75,303.77,38,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,178.75,178.75,180.35,118,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,56.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,118,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,59.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,266,266,266,13,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,111.72,111.72,111.72,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.1,5.1,5.25,2124,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,56.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,59.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,389,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,57.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,56.46,448,,facility
UNLISTED PROCEDURE STOMACH,43999,CPT,750,RC,,,,outpatient,,,1079.61,107.96,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,868.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,868.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,894.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,868.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1814.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,920.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,868.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,920.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3821,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,885.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3821,,facility
SARSCOV CORONAVIRUS AG IA,87426,CPT,300,RC,,,,outpatient,,,44.16,4.42,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,79.4,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,36.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.33,448,,facility
RHEUMATOID FACTOR QUANT,86431,CPT,302,RC,,,,outpatient,,,7.09,0.71,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.04,5.04,5.04,26,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,33.63,33.63,33.63,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,30.1,19.05,30.1,1 through 10,percent of total billed charges,,,33.6,,19.15,19.15,30.1,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,19.15,19.15,19.24,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,11.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.04,5.04,5.04,75,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.25,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.67,448,,facility
MSH6 GENE KNOWN VARIANTS,81299,CPT,310,RC,,,,outpatient,,,385,38.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,308,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,308,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,317.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,308,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,643.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,326.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,308,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,326.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,539,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,314.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,308,643.72,,facility
IMMUNOASSAY NONANTIBODY,83516,CPT,301,RC,,,,outpatient,,,14.41,1.44,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9,9,10.26,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,4.75,4.75,218.59,30,percent of total billed charges,,,33.6,,3.02,3.02,175.39,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,3.02,3.02,211.68,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,24.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,23.5,23.5,23.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9,9,10.26,51,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.92,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,11.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.53,448,,facility
TREAT THIGH FRACTURE,27238,CPT,450,RC,,,,outpatient,,,1914.16,191.42,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1585.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3216.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1631.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1631.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1569.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3216.38,,facility
ASSAY OF URINE OSMOLALITY,83935,CPT,301,RC,,,,outpatient,,,8.53,0.85,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,6.07,6.07,6.07,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,62.3,62.3,62.3,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,39.65,39.65,39.65,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,14.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,7.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,17,17,17,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,6.07,6.07,6.07,11,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,7.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.74,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,6.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,6.82,448,,facility
COOMBS TEST DIRECT,86880,CPT,302,RC,,,,outpatient,,,72.85,7.29,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,52.12,52.12,52.12,13,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,56.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,56.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,58.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,272.45,57.02,294.64,27,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,57.79,57.79,57.79,1 through 10,percent of total billed charges,,,34.6,,187.31,187.31,187.31,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,56.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,118,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,59.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.79,4.79,4.79,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,56.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,59.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.64,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,57.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.64,448,,facility
EXC H-F-NK-SP B9+MARG 0.5/<,11420,CPT,761,RC,,,,outpatient,,,1930.94,193.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1628.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3303.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1675.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1675.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,1612.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3303.62,,facility
BRAF GENE,81210,CPT,310,RC,,,,outpatient,,,219.25,21.93,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,156.02,156.02,156.02,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,175.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,175.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,180.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,175.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,366.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,185.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,156.02,156.02,156.02,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,175.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,185.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,306.95,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,178.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,175.4,448,,facility
ASSAY OF PROCAINAMIDE,80192,CPT,301,RC,,,,outpatient,,,20.94,2.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,35.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.19,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,16.75,448,,facility
HB GLYCOSYLATED A1C HOME DEV,83037,CPT,301,RC,,,,outpatient,,,12.14,1.21,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,9.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,20.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,9.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.98,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,9.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,9.71,448,,facility
RUBEOLA ANTIBODY,86765,CPT,302,RC,,,,outpatient,,,16.1,1.61,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.46,11.46,11.46,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,22.18,22.18,83.95,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,20.68,20.68,20.68,1 through 10,percent of total billed charges,,,34.6,,61.35,61.35,61.35,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,26.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,44,44,44,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.46,11.46,11.46,18,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.88,448,,facility
CT ABD & PELVIS W/O CONTRAST,74176,CPT,352,RC,,,,outpatient,,,291.84,29.18,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,212.09,210.64,228.36,88,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,403,,,,,,,case rate,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,371,,,,,,,case rate,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,411,378,411,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,875,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1050,,,,,,,case rate,NTE Percentage + Reimbursement Rate 85.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,235.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,5815.06,3421.82,5815.07,26,percent of total billed charges,,,33.6,,3421.82,3421.82,5377.15,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,3421.82,3421.82,3452.38,16,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,477.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,242.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,1280.81,1280.81,1280.81,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,84.69,84.69,88.54,88,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,242.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1522,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,232.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,228.36,1522,,facility
"BRACHYTX, NON-STRANDED,C-131",C2643,HCPCS,278,RC,,,,outpatient,,,100.41,10.04,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,66,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,61,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,99.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,99.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,102.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,99.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,207.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,105.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,99.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,105.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,101.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,99.31,207.56,,facility
APPL SHORT ARM SPLINT STATIC,29125,CPT,450,RC,,,,outpatient,,,152.14,15.21,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,131.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,266.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,134.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,134.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,129.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,127.33,448,,facility
IG LIGHT CHAINS FREE EACH,83521,CPT,301,RC,,,,outpatient,,,21.59,2.16,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,52.42,52.42,52.42,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,36.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,16,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.22,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.27,448,,facility
PTEN GENE KNOWN FAM VARIANT,81322,CPT,310,RC,,,,outpatient,,,58.25,5.83,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,46.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,46.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,46.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,97.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,49.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,46.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,49.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,92.49,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,47.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,46.6,448,,facility
FIBRINOLYSINS SCREEN I&R,85390,CPT,305,RC,,,,outpatient,,,19.35,1.94,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.77,13.77,13.77,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,24.82,24.82,24.82,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,9.07,9.07,9.07,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,32.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.77,13.77,13.77,12,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.09,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,15.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,15.48,448,,facility
ASSAY OF PROTEIN SERUM,84155,CPT,301,RC,,,,outpatient,,,4.59,0.46,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.26,3.26,3.26,55,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,23.6,23.6,23.6,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,316,316,316,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,180.44,21.12,180.44,76,percent of total billed charges,,,33.6,,106.18,13.44,180.44,18,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,106.18,13.44,107.12,57,percent of total billed charges,,,34.6,,120.4,120.4,120.4,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,7.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,158,20,158,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,8.4,8.4,8.4,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.26,3.26,3.26,650,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.93,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,3.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,3.67,448,,facility
CHANGE OF WINDPIPE AIRWAY,31502,CPT,761,RC,,,,outpatient,,,290.91,29.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,226.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,226.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,233.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,226.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,473.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,240.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,226.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,240.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,231.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,226.68,1173,,facility
OTHER SOURCE ALBUMIN QUAN EA,82042,CPT,301,RC,,,,outpatient,,,9.73,0.97,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,107.76,107.76,107.76,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,7.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,16.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,6.92,6.92,6.92,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,7.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.62,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,7.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,7.78,448,,facility
BIOPSY NAIL UNIT,11755,CPT,761,RC,,,,outpatient,,,837.95,83.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,677.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,677.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,698.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,677.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1416.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,718.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,677.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,718.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,691.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1416.43,,facility
INTMD RPR FACE/MM 5.1-7.5 CM,12053,CPT,761,RC,,,,outpatient,,,474.9,47.49,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,400.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,813.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,412.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,412.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,396.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,389.05,1173,,facility
REMOVE IMPACTED EAR WAX UNI,69210,CPT,761,RC,,,,outpatient,,,72.85,7.29,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,56.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,56.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,58.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,56.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,118,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,59.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,56.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,59.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,57.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,56.46,1173,,facility
RUBELLA ANTIBODY,86762,CPT,302,RC,,,,outpatient,,,17.99,1.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.8,12.8,12.8,18,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,28.32,28.32,28.32,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,25.34,16.13,25.34,14,percent of total billed charges,,,33.6,,16.13,16.13,16.13,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,16.13,16.13,16.27,22,percent of total billed charges,,,34.6,,68.61,68.61,68.61,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,30.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,24,24,44.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,12.8,12.8,12.8,1 through 10,percent of total billed charges,,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.8,12.8,12.8,185,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,31.1,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.39,448,,facility
ASSAY OF TOTAL THYROXINE,84436,CPT,301,RC,,,,outpatient,,,8.59,0.86,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,6.11,6.11,6.11,16,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,29.04,18.48,252.95,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,18.56,18.48,150.18,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,14.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,7.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,6.11,6.11,6.11,40,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,7.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.84,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,7.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,6.87,448,,facility
BRCA1 GENE FULL SEQ ALYS,81165,CPT,310,RC,,,,outpatient,,,353.6,35.36,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,282.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,282.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,291.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,282.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,591.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,299.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,282.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,299.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,495.04,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,288.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,282.88,591.22,,facility
IMAGE CATH FLUID COLXN VISC,49405,CPT,361,RC,,,,outpatient,,,1930.94,193.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1628.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3303.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1675.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1675.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3821,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1612.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3821,,facility
CLOT FACTOR II PROTHROM SPEC,85210,CPT,305,RC,,,,outpatient,,,16.23,1.62,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.55,11.55,11.55,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.55,11.55,11.55,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.05,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.98,448,,facility
NJX PX NFROSGRM &/URTRGRM,50431,CPT,361,RC,,,,outpatient,,,813.58,81.36,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,667.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,667.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,687.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,667.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1394.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,707.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,667.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,707.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2712,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,680.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,2712,,facility
ECHO TRANSESOPHAGEAL INTRAOP,93318,CPT,483,RC,,,,outpatient,,,657.04,65.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,522.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,522.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,538.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,522.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1092.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,554.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,522.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,554.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,566,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,533.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1092.97,,facility
ENCEPHALTIS ST LOUIS ANTBODY,86653,CPT,302,RC,,,,outpatient,,,16.49,1.65,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.49,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.19,448,,facility
DRAINAGE OF BURSA OF FOOT,28001,CPT,450,RC,,,,outpatient,,,1930.94,193.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1628.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3303.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1675.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1675.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1612.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3303.62,,facility
SHAVE SKIN LESION 1.1-2.0 CM,11312,CPT,761,RC,,,,outpatient,,,474.9,47.49,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,400.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,813.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,412.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,412.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,396.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,389.05,813.11,,facility
PM DEVICE PROGR EVAL MULTI,93281,CPT,480,RC,,,,outpatient,,,44.91,4.49,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,35.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,74.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,33.98,33.98,33.98,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1463,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,36.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.71,1463,,facility
RUSSELL VIPER VENOM DILUTED,85613,CPT,305,RC,,,,outpatient,,,11.98,1.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,8.52,8.52,8.52,20,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,82.37,20.06,82.37,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,52.42,52.42,52.42,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,9.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,20.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,8.52,8.52,8.52,34,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,9.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.7,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,9.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,9.58,448,,facility
TIS TRNFR F/C/C/M/N/A/G/H/F,14041,CPT,761,RC,,,,outpatient,,,2171.91,217.19,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1027,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1519,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1974.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1974.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2033.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1974.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,4127.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2093.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1974.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2093.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,2014.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,4127.08,,facility
MOPATH PROCEDURE LEVEL 7,81406,CPT,310,RC,,,,outpatient,,,353.6,35.36,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,282.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,282.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,291.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,282.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,591.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,299.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,282.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,299.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,495.04,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,288.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,282.88,591.22,,facility
ULTRASOUND BREAST COMPLETE,76641,CPT,402,RC,,,,outpatient,,,130.94,13.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,465,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,465,,facility
HC PRIVATE ROOM DAILY,1.1E+12,CDM,110,RC,,,,inpatient,,,469,46.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Stoploss First Dollar + Reimbursement Rate 64.00 + Basic Per Diem + Fixed Rate 2234.00 + Fixed Amount 106065.00,,,,0,other,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,Stoploss First Dollar + Reimbursement Rate 64.00 + Basic Per Diem + Fixed Rate 5518.00 + Fixed Amount 106065.00,,,,0,other,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Short Stay Lesser of + Days Threshold 1.00 + Stoploss First Dollar + Reimbursement Rate 57.00 + Basic Per Diem + Fixed Rate 5000.00 + Fixed Amount 157464.00,,,,0,other,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,Short Stay Lesser of + Days Threshold 1.00 + Stoploss First Dollar + Reimbursement Rate 72.00 + Basic Per Diem + Fixed Rate 10000.00 + Fixed Amount 56687.00,,,,0,other,NTE Percentage + Reimbursement Rate 85.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,47.3,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,facility
TRANSVAGINAL US NON-OB,76830,CPT,402,RC,,,,outpatient,,,130.94,13.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,93.3,92.3,100.06,46,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,1185.92,1185.92,1185.92,23,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,1093.27,1093.27,1093.27,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,978.38,622.61,1058.06,11,percent of total billed charges,,,33.6,,628.17,622.61,978.38,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,622.61,622.61,628.17,21,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,926.5,926.5,926.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,68.76,68.76,72.43,35,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,465,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,465,,facility
X-RAY EXAM OF LOWER LEG,73590,CPT,320,RC,,,,outpatient,,,108.23,10.82,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,85.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,174.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.41,19.41,19.97,77,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,84.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,83.29,448,,facility
ASSAY C-D TRANSFER MEASURE,82373,CPT,301,RC,,,,outpatient,,,22.58,2.26,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,37.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,39.01,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.06,448,,facility
TX/PRO/DX INJ NEW DRUG ADDON,96375,CPT,260,RC,,,,outpatient,,,56.58,5.66,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,77.8,38.9,155.59,1844,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,389.12,149.76,778.24,275,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,179.36,41.09,896.8,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,44.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,44.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,46.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,204.29,102.14,481.54,233,percent of total billed charges,,,33.6,,160.51,160.51,510.72,133,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,204.29,102.14,408.58,198,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,44.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,93.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,47.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,304,304,304,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,127.68,49.14,127.68,12,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,82.18,41.09,164.36,1115,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,44.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,47.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,427,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,45.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,44.82,448,,facility
ASSAY OF G6PD ENZYME,82955,CPT,301,RC,,,,outpatient,,,12.13,1.21,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,9.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,20.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,9.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.95,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,9.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,9.7,448,,facility
BARTONELLA ANTIBODY,86611,CPT,302,RC,,,,outpatient,,,12.73,1.27,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,21.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9.05,9.05,9.05,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.98,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,10.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,10.18,448,,facility
PSYCL/NRPSYC TST PHY/QHP 1ST,96136,CPT,918,RC,,,,outpatient,,,152.14,15.21,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,117.45,117.45,127.33,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,131.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,266.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,134.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,134.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1372,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,129.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,127.33,1372,,professional
HEARING LOSS SEQUENCE ANALYS,81430,CPT,310,RC,,,,outpatient,,,2031.25,203.13,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1625,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1625,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1673.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1625,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3396.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1722.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1625,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1722.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2843.75,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1657.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3396.25,,facility
X-RAY EXAM OF KNEES,73565,CPT,320,RC,,,,outpatient,,,108.23,10.82,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,85.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,174.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,84.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,83.29,448,,facility
ASSAY OF ESTRONE,82679,CPT,301,RC,,,,outpatient,,,31.19,3.12,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,24.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,52.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,26.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,24.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,26.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,53.92,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,25.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,24.95,448,,facility
DRG XTRNL AUD CANAL ABSCESS,69020,CPT,450,RC,,,,outpatient,,,837.95,83.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,617.33,617.33,617.33,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,677.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,677.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,698.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,677.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1416.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,718.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,677.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,718.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,691.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1416.43,,facility
CYSTOSCOPY AND TREATMENT,52310,CPT,361,RC,,,,outpatient,,,2425.83,242.58,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,2000.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2000.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2060.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2000.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,4181.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2120.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2000.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2120.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3821,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,2040.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,4181.3,,facility
CT ORBIT/EAR/FOSSA W/O DYE,70480,CPT,351,RC,,,,outpatient,,,130.94,13.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,93.3,92.3,93.3,11,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,403,,,,,,,case rate,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,371,,,,,,,case rate,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,875,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1050,,,,,,,case rate,NTE Percentage + Reimbursement Rate 85.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,3244.03,3244.03,3508.22,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,3072,3072,3072,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,81.72,81.72,81.72,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1522,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,1522,,facility
EAR CARTILAGE GRAFT,21235,CPT,761,RC,,,,outpatient,,,6974.64,697.46,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2004,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,2759,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5665.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5665.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5835.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5665.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,11841.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6005.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5665.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6005.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,5778.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,11841.12,,facility
NEEDLE EMG 1 EXTREMITY,95860,CPT,922,RC,,,,outpatient,,,152.14,15.21,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,131.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,266.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,134.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,134.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,478,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,129.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,127.33,478,,facility
SHAVE SKIN LESION >2.0 CM,11313,CPT,761,RC,,,,outpatient,,,474.9,47.49,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,400.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,813.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,412.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,412.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,396.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,389.05,813.11,,facility
TRANSFERASE (AST) (SGOT),84450,CPT,301,RC,,,,outpatient,,,6.48,0.65,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.61,4.61,4.61,56,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,23.6,23.6,23.6,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,231.83,21.12,231.83,76,percent of total billed charges,,,33.6,,136.42,13.44,231.83,18,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,136.42,13.44,137.63,57,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,10.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,203,20,203,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,8.4,8.4,8.4,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.61,4.61,4.61,642,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.18,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.18,448,,facility
ASSAY THYROID STIM HORMONE,84443,CPT,301,RC,,,,outpatient,,,21,2.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,14.94,14.94,14.94,707,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,50.15,50.15,279.66,31,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,44.88,28.56,250.27,227,percent of total billed charges,,,33.6,,44.88,28.56,250.27,59,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,28.56,28.56,159.26,382,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,35.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,42.5,42.25,237,16,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,17.85,17.85,99.54,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,14.94,14.94,14.94,1704,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.31,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,16.8,448,,facility
CLTX TALUS FRACTURE W/MNPJ,28435,CPT,761,RC,,,,outpatient,,,1914.16,191.42,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1585.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3216.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1631.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1631.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,1569.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3216.38,,facility
ASSAY OF VITAMIN E,84446,CPT,301,RC,,,,outpatient,,,17.73,1.77,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.61,12.61,12.61,23,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,31.68,15.12,31.68,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,20.16,17.81,20.16,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,29.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.61,12.61,12.61,61,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.64,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.18,448,,facility
REPAIR LEAD PACE-DEFIB ONE,33218,CPT,361,RC,,,,outpatient,,,4677.03,467.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1268,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1793,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,3576.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3576.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3683.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3576.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,7474.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3791.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3576.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3791.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10137,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,3648.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,10137,,facility
CLSD TX PELVIC RING FX,27197,CPT,450,RC,,,,outpatient,,,280.86,28.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,243.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,493.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,240.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,236.08,1173,,facility
CLTX THIGH FX,27267,CPT,450,RC,,,,outpatient,,,3855.04,385.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3131.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3131.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3225.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3131.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,6544.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3319.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3131.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3319.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3194.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,6544.81,,facility
DOXORUBICIN INJ 10MG,Q2050,HCPCS,636,RC,,,,outpatient,,,170.28,17.03,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,116.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,116.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,120.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,116.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,243.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,123.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,116.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,123.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,292.51,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,118.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,116.61,448,,facility
ASSAY OF URINE/UREA-N,84540,CPT,301,RC,,,,outpatient,,,6.95,0.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,91.87,91.87,91.87,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,11.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,135.5,135.5,135.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.95,4.95,4.95,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.26,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.56,448,,facility
RENAL FUNCTION PANEL,80069,CPT,301,RC,,,,outpatient,,,10.85,1.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,7.72,7.72,7.72,44,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,32.45,7.72,32.45,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,29.04,18.48,254.93,17,percent of total billed charges,,,33.6,,18.48,18.48,18.48,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,18.48,18.48,252.67,27,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,18.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,9.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,27.5,27.5,27.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,7.72,7.72,7.72,276,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,9.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.76,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,8.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,8.68,448,,facility
REPAIR OF NAIL BED,11760,CPT,761,RC,,,,outpatient,,,748,74.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,707.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,707.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,728.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,707.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1478.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,749.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,707.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,749.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,721.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1478.34,,facility
CIRCUMCISION NEONATE,54160,CPT,361,RC,,,,outpatient,,,813.58,81.36,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,667.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,667.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,687.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,667.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1394.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,707.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,667.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,707.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9389,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,680.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,9389,,facility
CLTX HUMRL SHFT FX W/O MNPJ,24500,CPT,450,RC,,,,outpatient,,,280.86,28.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,243.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,493.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,240.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,236.08,1173,,facility
PLACE DUOD/JEJ TUBE PERC,49441,CPT,361,RC,,,,outpatient,,,2266.24,226.62,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,1836.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1836.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1891.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1836.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3838.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1946.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1836.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1946.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3821,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1873.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3838.31,,facility
AMINO ACIDS SINGLE QUANT,82131,CPT,301,RC,,,,outpatient,,,28.73,2.87,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,23.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,48.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,24.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,24.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,40.22,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,23.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,22.98,448,,facility
UNLISTD NONINVAS VASC DX STD,93998,CPT,921,RC,,,,outpatient,,,35.46,3.55,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,27.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,57.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,29.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,27.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,29.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1227,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,28.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,27.68,1227,,facility
LAPAROSCOPY LYMPHADENECTOMY,38571,CPT,761,RC,,,,outpatient,,,12259.7,1225.97,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2697,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,3451,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10173.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10173.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10478.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10173.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,21262.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10783.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10173.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10783.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,10376.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,21262.32,,facility
IPILIMUMAB INJECTION,J9228,HCPCS,636,RC,,,,outpatient,,,220.98,22.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,190.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,190.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,196.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,190.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,398,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,201.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,190.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,201.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,387.11,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,194.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,190.43,448,,facility
APPL CAST HAND&LWR FOREARM,29085,CPT,761,RC,,,,outpatient,,,187.66,18.77,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,155.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,155.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,160.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,155.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,325.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,164.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,155.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,164.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,158.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,155.52,448,,facility
HPV HI-RISK TYP POOLED RSLT,87624,CPT,306,RC,,,,outpatient,,,43.86,4.39,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,51,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,57.23,57.23,57.23,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,85.34,51.22,134.11,1 through 10,percent of total billed charges,,,33.6,,32.59,32.59,85.34,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,85.34,75.94,85.34,14,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,112,48.5,112,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,20.37,20.37,53.34,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,80,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
PATIENT RECORDED SPIROMETRY,94014,CPT,460,RC,,,,outpatient,,,474.54,47.45,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,427.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,427.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,440.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,427.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,893.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,453.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,427.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,453.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,611,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,436.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,427.54,893.56,,facility
TREAT LOWER LEG DISLOCATION,27831,CPT,450,RC,,,,outpatient,,,3855.04,385.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3131.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3131.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3225.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3131.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,6544.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3319.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3131.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3319.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3194.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,6544.81,,facility
MOPATH PROCEDURE LEVEL 6,81405,CPT,310,RC,,,,outpatient,,,376.69,37.67,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,301.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,301.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,310.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,301.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,629.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,319.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,301.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,319.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,527.36,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,307.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,301.35,629.82,,facility
CMV ANTIBODY,86644,CPT,302,RC,,,,outpatient,,,17.99,1.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.8,12.8,12.8,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,30.08,30.08,85.12,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,70.22,44.69,76.56,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,49.24,48.72,49.24,1 through 10,percent of total billed charges,,,34.6,,48.28,17.91,50.67,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,30.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.8,12.8,12.8,11,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,31.1,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.39,448,,facility
IMAGE CATH FLUID TRNS/VGNL,49407,CPT,361,RC,,,,outpatient,,,1930.94,193.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1027,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1519,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1628.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3303.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1675.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1675.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3821,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1612.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3821,,facility
"INJECTION, NIVOLUMAB",J9299,HCPCS,636,RC,,,,outpatient,,,39.5,3.95,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,34.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,34.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,32947.2,32947.2,32947.2,4320,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,34.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,71.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,36.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,34.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,36.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,69.45,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,34.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,34.22,448,,facility
PLANNED TRACHEOSTOMY,31600,CPT,510,RC,,,,outpatient,,,3834.53,383.45,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3173.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3173.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3268.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3173.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,6631.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3363.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3173.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3363.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,3236.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,6631.76,,facility
IMMUNOASSAY INFECTIOUS AGENT,86317,CPT,302,RC,,,,outpatient,,,18.74,1.87,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.33,13.33,13.33,86,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,59,59,59,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,52.8,26.54,52.8,41,percent of total billed charges,,,33.6,,52.8,33.6,52.8,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,33.6,33.6,33.73,52,percent of total billed charges,,,34.6,,218.53,218.53,218.53,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,31.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,50,50,50,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.33,13.33,13.33,209,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.38,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,15.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.99,448,,facility
ASSAY OF PROSTAGLANDIN,84150,CPT,301,RC,,,,outpatient,,,52.21,5.22,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,41.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,41.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,43.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,41.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,87.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,44.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,41.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,44.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,73.1,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,42.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,41.77,448,,facility
CLTX TALUS FRACTURE W/O MNPJ,28430,CPT,450,RC,,,,outpatient,,,280.86,28.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,243.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,493.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,240.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,236.08,1173,,facility
THROMBOPLASTIN TIME PARTIAL,85730,CPT,305,RC,,,,outpatient,,,7.51,0.75,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.35,5.35,5.35,44,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,17.28,17.28,226.56,25,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,208.86,15.93,208.86,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,186.91,11.69,202.13,44,percent of total billed charges,,,33.6,,118.94,9.07,237.89,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,118.94,9.07,120.01,25,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,12.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,177,13.5,177,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.35,5.35,5.35,310,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.99,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,6.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,6.01,448,,facility
ASSAY ANTI-MULLERIAN HORM,82166,CPT,301,RC,,,,outpatient,,,48.28,4.83,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,39.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,98.74,98.74,118.27,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,62.83,62.83,63.39,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,38.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,80.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,40.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,93.5,93.5,93.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,38.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,40.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,67.59,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,39.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,38.62,448,,facility
HYDRATION IV INFUSION INIT,96360,CPT,260,RC,,,,outpatient,,,255.28,25.53,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,184.86,173.06,191.54,106,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,442.88,442.88,442.88,12,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,203.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,203.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,209.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,365.38,232.51,365.38,23,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,232.51,232.51,232.51,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,203.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,425.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,215.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,346,346,346,20,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,187.62,187.62,191.54,94,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,203.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,215.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,427,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,207.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,203.57,448,,facility
CYTOGENETICS DNA PROBE,88271,CPT,311,RC,,,,outpatient,,,26.78,2.68,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.05,19.05,19.05,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,1274.11,1274.11,1274.11,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,477.79,477.79,477.79,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,21.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,44.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.05,19.05,19.05,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,21.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,46.27,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,21.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,21.42,448,,facility
HRDTRY BRST CA-RLATD DO 5+,81432,CPT,310,RC,,,,outpatient,,,848.81,84.88,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1303.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1303.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1343.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,2654.4,2654.4,2654.4,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1303.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,2725.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1382.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1303.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1382.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1467.08,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1330.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,2725.26,,facility
IGH VARI REGIONAL MUTATION,81263,CPT,310,RC,,,,outpatient,,,368.15,36.82,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,294.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,294.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,303.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,294.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,615.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,312.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,294.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,312.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,636.3,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,300.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,294.52,636.3,,facility
ASSAY OF C-PEPTIDE,84681,CPT,301,RC,,,,outpatient,,,26.01,2.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,18.51,18.51,18.51,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,283.54,283.54,283.54,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,54.1,54.1,54.58,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,20.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,43.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,18.51,18.51,18.51,11,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,20.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,44.98,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,21.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,20.81,448,,facility
EGD TUBE/CATH INSERTION,43241,CPT,750,RC,,,,outpatient,,,2266.24,226.62,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,1836.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1836.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1891.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1836.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3838.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1946.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1836.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1946.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3821,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1873.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3838.31,,facility
INTMD RPR N-HF/GENIT 2.5CM/<,12041,CPT,761,RC,,,,outpatient,,,474.9,47.49,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,400.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,813.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,412.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,177.9,177.9,177.9,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,412.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,396.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,389.05,1173,,facility
URINALYSIS AUTO W/SCOPE,81001,CPT,307,RC,,,,outpatient,,,3.96,0.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,2.82,2.82,2.82,418,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,229.76,25.6,256,88,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,211.81,23.6,236,14,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,204.99,21.12,228.4,143,percent of total billed charges,,,33.6,,134.4,21.12,189.55,25,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,121.7,13.44,135.6,151,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,6.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,179.5,20,200,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,8.4,8.4,84,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,2.82,2.82,2.82,1909,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.86,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,3.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,3.17,448,,facility
CHLAMYDIA IGM ANTIBODY,86632,CPT,302,RC,,,,outpatient,,,15.85,1.59,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,26.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.41,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.68,448,,facility
SMEAR SPECIAL STAIN,87207,CPT,306,RC,,,,outpatient,,,7.49,0.75,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,39.53,39.53,574.66,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,12.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.95,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,6.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.99,448,,facility
INCAL BX SKN SINGLE LES,11106,CPT,761,RC,,,,outpatient,,,748,74.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,707.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,707.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,728.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,707.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1478.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,749.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,707.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,749.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,721.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1478.34,,facility
ESOPH IMPED FUNCTION TEST,91037,CPT,750,RC,,,,outpatient,,,373.83,37.38,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,206.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,206.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,212.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,206.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,431.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,219.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,206.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,219.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2440,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,210.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,206.65,2440,,facility
PLATELET ANTIBODIES,86022,CPT,302,RC,,,,outpatient,,,22.96,2.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.34,16.34,16.34,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,39.69,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.37,448,,facility
CLOSED TX NOSE/JAW FX,21345,CPT,450,RC,,,,outpatient,,,1816.31,181.63,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2004,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,2759,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1484.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1484.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1529.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1484.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3103.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1574.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1484.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1574.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1514.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3103.57,,facility
TREAT KNEE FRACTURE,27530,CPT,761,RC,,,,outpatient,,,280.86,28.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,243.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,493.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,240.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,236.08,1173,,facility
PRGRMG DEV EVAL PM/LDLS PM,93279,CPT,480,RC,,,,outpatient,,,44.91,4.49,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,32.72,32.72,32.72,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,145.92,145.92,145.92,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,35.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,74.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1463,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,36.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.71,1463,,facility
BETA-2 GLYCOPROTEIN ANTIBODY,86146,CPT,302,RC,,,,outpatient,,,31.81,3.18,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,22.64,22.64,22.64,11,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,90.82,24.82,293.57,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,57.79,57.79,186.82,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,25.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,53.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,26.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,128.1,128.1,128.1,1 through 10,percent of total billed charges,,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,22.64,22.64,22.64,25,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,25.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,26.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,54.99,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,25.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,25.45,448,,facility
LOWER EXTREMITY STUDY,93926,CPT,921,RC,,,,outpatient,,,130.94,13.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1227,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,1227,,facility
APPL LONG LEG CAST WALKER,29355,CPT,450,RC,,,,outpatient,,,319.85,31.99,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,267.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,267.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,275.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,267.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,559.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,283.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,267.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,283.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,273.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,267.68,559.45,,facility
ASSAY OF PHENYTOIN TOTAL,80185,CPT,301,RC,,,,outpatient,,,16.56,1.66,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,70.22,70.22,70.22,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,44.69,44.69,44.69,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.79,11.79,11.79,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.63,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.25,448,,facility
RBC DEGLYCEROLIZED,P9039,HCPCS,390,RC,,,,outpatient,,,388.89,38.89,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,311.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,311.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,320.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,311.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,650.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,330.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,311.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,330.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,107,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,317.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,107,650.97,,facility
NASOPHARYNGOSCOPY,92511,CPT,761,RC,,,,outpatient,,,235.91,23.59,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,191.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,191.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,196.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,191.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,399.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,202.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,191.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,202.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,194.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,191.04,1173,,facility
RIA NONANTIBODY,83519,CPT,301,RC,,,,outpatient,,,23,2.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,55.44,55.44,55.44,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.37,16.37,16.37,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.2,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.4,448,,facility
HOME SLEEP TEST/TYPE 3 PORTA,G0399,HCPCS,920,RC,,,,outpatient,,,186.04,18.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,672,584.32,672,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,206.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,206.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,212.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,554.4,554.4,554.4,1 through 10,percent of total billed charges,,,33.6,,554.4,554.4,554.4,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,352.8,309.51,352.8,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,206.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,431.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,219.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,525,525,525,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,206.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,219.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,422,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,210.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,206.65,448,,facility
TRANSJ CARE MGMT HIGH F2F 7D,99496,CPT,510,RC,,,,outpatient,,,157.44,15.74,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,127.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,127.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,131.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,127.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,266.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,135.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,127.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,135.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,129.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,127.42,448,,facility
HPA-1 GENOTYPING,81105,CPT,310,RC,,,,outpatient,,,152.78,15.28,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,122.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,122.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,125.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,122.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,255.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,129.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,122.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,129.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,264.06,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,124.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,122.22,448,,facility
CLOT INHIBIT PROT C ANTIGEN,85302,CPT,305,RC,,,,outpatient,,,15.01,1.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.68,10.68,10.68,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,90.05,90.05,90.05,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.68,10.68,81.75,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.95,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.01,448,,facility
ANGIOTENSIN I ENZYME TEST,82164,CPT,301,RC,,,,outpatient,,,18.25,1.83,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.99,12.99,12.99,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,42.67,12.77,67.06,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,42.88,42.88,42.88,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,30.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.99,12.99,12.99,26,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,31.55,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.6,448,,facility
ASSAY OF LIDOCAINE,80176,CPT,301,RC,,,,outpatient,,,18.36,1.84,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,30.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,31.75,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.69,448,,facility
APPLY SURF LDR RADIONUCLIDE,77789,CPT,342,RC,,,,outpatient,,,142.81,14.28,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,97.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,97.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,97.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,204.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,103.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,97.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,103.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1945,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,99.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,97.65,1945,,facility
NFCT AGT GNTYP ALYS HEP C,87902,CPT,306,RC,,,,outpatient,,,321.81,32.18,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,229,229,229,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,257.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,257.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,265.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,257.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,538.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,272.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,229,229,229,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,257.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,272.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,556.22,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,262.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,257.45,556.22,,facility
MYCOBACTERIC IDENTIFICATION,87118,CPT,306,RC,,,,outpatient,,,18.26,1.83,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,30.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.57,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.61,448,,facility
I&D UPR A/E DP ABSC/HMTMA,23930,CPT,450,RC,,,,outpatient,,,3384.19,338.42,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2779.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2779.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2863.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2779.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,5810.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2946.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2779.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2946.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2835.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,5810.16,,facility
TB INTRADERMAL TEST,86580,CPT,302,RC,,,,outpatient,,,35.46,3.55,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,27.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,57.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,29.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,27.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,29.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.57,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,28.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,27.68,448,,facility
N BLOCK LUMBAR/THORACIC,64520,CPT,361,RC,,,,outpatient,,,1085.56,108.56,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,846.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,846.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,871.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,846.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1769.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,897.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,792.82,792.82,792.82,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,846.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,897.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2712,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,863.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,2712,,facility
CRYOPRECIPITATE EACH UNIT,P9012,HCPCS,390,RC,,,,outpatient,,,74.84,7.48,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,71.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,71.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,73.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,536.98,536.98,536.98,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,71.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,149.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,75.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,71.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,75.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,107,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,73.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,71.6,448,,facility
CONIZATION OF CERVIX,57520,CPT,761,RC,,,,outpatient,,,3723.46,372.35,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3098.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3098.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3191.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3098.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,6475.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3284,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3098.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3284,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,3160.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,6475.05,,facility
TX SUPFC WND DEHSN W/PACKING,12021,CPT,761,RC,,,,outpatient,,,474.9,47.49,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,350.55,350.55,350.55,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,400.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,813.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,412.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,412.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,396.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,389.05,1173,,facility
MOPATH PROCEDURE LEVEL 3,81402,CPT,310,RC,,,,outpatient,,,187.91,18.79,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,150.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,150.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,154.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,150.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,314.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,159.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,150.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,159.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,263.08,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,153.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,150.33,448,,facility
UNLISTED PX EXTERNAL EAR,69399,CPT,510,RC,,,,outpatient,,,290.91,29.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,226.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,226.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,233.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,226.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,473.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,240.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,226.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,240.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,231.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,226.68,473.76,,facility
CHANGE STENT VIA TRANSURETH,50385,CPT,761,RC,,,,outpatient,,,2425.83,242.58,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2000.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2000.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2060.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2000.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,4181.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2120.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2000.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2120.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,2040.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,4181.3,,facility
PROTEIN E-PHORESIS/URINE/CSF,84166,CPT,301,RC,,,,outpatient,,,22.29,2.23,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.86,15.86,15.86,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,21.5,21.5,21.5,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,21.58,21.58,21.58,1 through 10,percent of total billed charges,,,34.6,,87.63,87.63,89.3,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,37.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.86,15.86,15.86,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.52,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.83,448,,facility
DEOXYCORTISOL,82634,CPT,301,RC,,,,outpatient,,,36.6,3.66,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,29.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,61.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,31.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,29.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,31.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,63.25,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,29.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,29.28,448,,facility
X-RAY XM UPR GI TRC 2CNTRST,74246,CPT,320,RC,,,,outpatient,,,218.83,21.88,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,172.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,350.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,177.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,177.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,171.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,167.87,448,,facility
X-RAY EXAM OF SKULL,70260,CPT,320,RC,,,,outpatient,,,130.94,13.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,448,,facility
TISSUE EXAM FOR FUNGI,87220,CPT,306,RC,,,,outpatient,,,5.34,0.53,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.8,3.8,3.8,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,8.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.8,3.8,3.8,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.22,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,4.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,4.27,448,,facility
TRB@ GENE REARRANGE AMPLIFY,81340,CPT,310,RC,,,,outpatient,,,261.15,26.12,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,185.83,185.83,185.83,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,208.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,208.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,215.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,208.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,436.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,221.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,208.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,221.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,451.36,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,213.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,208.92,451.36,,facility
DX LARYNGOSCOPY EXCL NB,31525,CPT,361,RC,,,,outpatient,,,2021.43,202.14,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,1513.06,1513.06,1513.06,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,1703.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1703.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1754.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1703.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3560.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1805.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1703.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1805.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3821,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1737.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3821,,facility
BIOPSY OF URETHRA,53200,CPT,761,RC,,,,outpatient,,,2425.83,242.58,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2000.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2000.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2060.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2000.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,4181.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2120.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2000.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2120.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,2040.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,4181.3,,facility
REM INTERROG DEV EVAL ICPMS,93297,CPT,480,RC,,,,outpatient,,,44.91,4.49,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,35.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,74.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1463,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,36.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.71,1463,,facility
CHROMOSOME ANALYSIS 100,88249,CPT,311,RC,,,,outpatient,,,216.46,21.65,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,173.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,173.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,178.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,173.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,361.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,183.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,173.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,183.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,374.15,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,176.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,173.17,448,,facility
ISLET CELL ANTIBODY,86341,CPT,302,RC,,,,outpatient,,,29.46,2.95,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,20.97,20.97,20.97,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,23.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,23.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,143.62,143.62,326.83,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,258.38,258.38,258.38,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,23.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,49.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,24.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,20.97,20.97,20.97,14,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,23.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,24.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.75,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,24.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,23.57,448,,facility
INTMD RPR N-HF/GENIT7.6-12.5,12044,CPT,761,RC,,,,outpatient,,,748,74.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,707.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,707.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,728.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,707.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1478.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,749.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,707.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,749.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,721.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1478.34,,facility
ASSAY OF CITRATE,82507,CPT,301,RC,,,,outpatient,,,34.75,3.48,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,27.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,58.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,29.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,27.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,29.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,60.08,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,28.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,27.8,448,,facility
XTRNL ECG REC<48 HRS REC,93225,CPT,731,RC,,,,outpatient,,,152.14,15.21,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,131.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,372.96,372.96,372.96,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,266.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,134.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,134.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,725,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,129.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,127.33,725,,facility
COMPLEMENT TOTAL (CH50),86162,CPT,302,RC,,,,outpatient,,,25.4,2.54,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,36.62,36.62,36.62,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,20.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,42.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,21.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,18.07,18.07,18.07,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,20.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,21.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,43.91,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,20.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,20.32,448,,facility
X-RAY EXAM HIPS BI 2 VIEWS,73521,CPT,320,RC,,,,outpatient,,,130.94,13.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,448,,facility
CHORIONIC GONADOTROPIN TEST,84702,CPT,301,RC,,,,outpatient,,,18.81,1.88,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.39,13.39,13.39,99,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,35.99,35.99,146.32,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,32.21,32.21,141.61,16,percent of total billed charges,,,33.6,,32.21,20.5,83.33,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,20.5,20.5,83.33,45,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,31.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,12.81,12.81,12.81,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,13.39,13.39,13.39,1 through 10,percent of total billed charges,,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.39,13.39,13.39,208,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.53,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,15.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,15.05,448,,facility
GASTROESOPHAGEAL REFLUX TEST,91034,CPT,750,RC,,,,outpatient,,,638.35,63.84,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,357.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,357.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,367.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,357.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,746.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,378.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,357.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,378.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2440,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,364.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,357.13,2440,,facility
CIRCUM 28 DAYS OR OLDER,54161,CPT,361,RC,,,,outpatient,,,2425.83,242.58,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,2000.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2000.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2060.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2000.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,4181.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2120.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2000.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2120.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9389,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,2040.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,9389,,facility
X-RAY EXAM OF ELBOW,73080,CPT,320,RC,,,,outpatient,,,108.23,10.82,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,85.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,174.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.68,19.68,39.36,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,84.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,83.29,448,,facility
ENTEROVIRUS ANTIBODY,86658,CPT,302,RC,,,,outpatient,,,16.29,1.63,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.14,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.03,448,,facility
EXCISION NAIL&NAIL MATRIX,11750,CPT,761,RC,,,,outpatient,,,474.9,47.49,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,400.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,813.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,412.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,412.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,396.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,389.05,1173,,facility
ASSAY OF GENTAMICIN,80170,CPT,301,RC,,,,outpatient,,,20.48,2.05,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,34.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.39,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,16.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,16.38,448,,facility
HTLV/HIV CONFIRMJ ANTIBODY,86689,CPT,302,RC,,,,outpatient,,,24.19,2.42,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,40.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,20.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,20.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,41.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,19.35,448,,facility
TREAT FOOT DISLOCATION,28600,CPT,450,RC,,,,outpatient,,,280.86,28.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,243.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,493.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,240.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,236.08,1173,,facility
INTMD RPR S/A/T/EXT 2.6-7.5,12032,CPT,761,RC,,,,outpatient,,,474.9,47.49,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,175.27,175.27,183.04,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,400.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,813.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,412.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,177.9,177.9,355.79,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,412.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,396.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,389.05,1173,,facility
COAGULATION TIME ACTIVATED,85347,CPT,305,RC,,,,outpatient,,,5.35,0.54,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,57.12,38.17,224.4,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,8.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.81,3.81,3.81,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.21,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,4.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,4.28,448,,facility
CLTX SPRCNDYLR HUMERAL FX W/,24535,CPT,761,RC,,,,outpatient,,,1914.16,191.42,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1585.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3216.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1631.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1631.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,1569.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3216.38,,facility
SARSCOV2 & INF A&B AMP PRB,87636,CPT,300,RC,,,,outpatient,,,178.29,17.83,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,126.87,126.87,126.87,1435,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,142.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,142.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,146.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,107.92,63.5,107.92,174,percent of total billed charges,,,33.6,,63.5,63.5,107.92,36,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,63.5,63.5,63.5,41,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,142.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,298.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,151.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,94.5,72.5,94.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,126.87,126.87,126.87,1370,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,142.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,151.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,249.55,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,145.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,142.63,448,,facility
MOPATH PROCEDURE LEVEL 4,81403,CPT,310,RC,,,,outpatient,,,231.5,23.15,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,185.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,185.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,190.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,322.39,322.39,322.39,1 through 10,percent of total billed charges,,,34.6,,397.12,397.12,397.12,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,185.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,387.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,196.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,185.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,196.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,324.1,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,188.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,185.2,448,,facility
CLOT FACTOR VIII AHG 1 STAGE,85240,CPT,305,RC,,,,outpatient,,,22.38,2.24,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.92,15.92,15.92,48,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,98.21,62.5,349.44,1 through 10,percent of total billed charges,,,33.6,,62.5,62.5,62.5,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,62.88,62.5,62.88,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,37.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,93,92.75,93,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.92,15.92,15.92,80,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.68,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.9,448,,facility
X-LINKED INTELLECTUAL DBLT,81471,CPT,310,RC,,,,outpatient,,,1142.5,114.25,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,914,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,914,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,941.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,914,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1910.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,968.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,914,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,968.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1599.5,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,932.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1910.26,,facility
I&D ABSCESS SIMPLE/SINGLE,10060,CPT,761,RC,,,,outpatient,,,238.44,23.84,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,174.34,174.34,176.95,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,197.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,401.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,203.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,176.95,176.95,176.95,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,203.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,195.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,192.01,1173,,facility
ASSAY OF B HEXOSAMINIDASE EA,83080,CPT,301,RC,,,,outpatient,,,21.09,2.11,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,35.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.45,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,16.87,448,,facility
ASSAY NONENDOCRINE RECEPTOR,84238,CPT,301,RC,,,,outpatient,,,45.71,4.57,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,37.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,36.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,76.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,38.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,36.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,38.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,79,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,37.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,36.57,448,,facility
PATHOLOGY EXAMINATION OF TISSUE USING A MICROSCOPE; LIMITED EXAMINATION,88300,CPT,0310,RC,,,,outpatient,,,77,7.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,14.72,14.72,14.72,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,44.9,44.9,44.9,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,26.1,26.1,26.1,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,27.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,57.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,29.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9.96,9.96,9.97,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,27.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,29.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.57,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,28.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,27.68,448,,facility
ASSAY OF PSA TOTAL,84153,CPT,301,RC,,,,outpatient,,,22.99,2.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.36,16.36,16.36,28,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,49.86,25.75,175.82,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,100.13,28.56,157.34,43,percent of total billed charges,,,33.6,,100.13,28.56,101.02,12,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,28.56,28.56,101.02,71,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,42.5,42.5,42.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,17.85,17.85,17.85,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.36,16.36,16.36,55,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,39.74,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.39,448,,facility
X-RAY EXAM OF FEMUR 2/>,73552,CPT,320,RC,,,,outpatient,,,108.23,10.82,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,85.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,174.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,21.83,21.83,22.47,28,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,84.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,83.29,448,,facility
PERICARDIOCENTESIS W/IMAGING,33016,CPT,481,RC,,,,outpatient,,,1907.41,190.74,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,1506.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1506.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1551.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1506.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3148.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1596.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1506.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1596.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2712,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1536.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3148.69,,facility
ASSAY OF ALDOSTERONE,82088,CPT,301,RC,,,,outpatient,,,50.94,5.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,36.25,36.25,36.25,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,32.45,32.45,63.72,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,40.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,40.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,41.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,29.04,18.48,29.04,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,18.48,17.81,46.37,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,40.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,85.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,43.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,36.25,36.25,36.25,24,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,40.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,43.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,88.04,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,41.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,40.75,448,,facility
RBC SICKLE CELL TEST,85660,CPT,305,RC,,,,outpatient,,,6.89,0.69,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.9,4.9,4.9,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,89.04,89.04,139.92,1 through 10,percent of total billed charges,,,33.6,,139.92,139.92,139.92,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,96.19,18.19,100.96,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,11.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,81.27,81.27,105.04,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.9,4.9,4.9,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.9,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.51,448,,facility
RPLC GTUBE REVJ GSTRST TRC,43763,CPT,750,RC,,,,outpatient,,,294.35,29.44,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,239.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,239.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,246.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,239.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,499.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,253.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,239.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,253.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2440,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,243.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,239.12,2440,,facility
EMR DPT VST MAYX REQ PHY/QHP,99281,CPT,450,RC,,,,outpatient,,,105.74,10.57,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,77.25,74.44,77.25,283,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,223,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,691,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,227,227,227,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,218,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1200,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1500,,,,,,,case rate,NTE Percentage + Reimbursement Rate 85.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,80.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,80.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,368.87,217.06,368.87,15,percent of total billed charges,,,33.6,,368.87,368.87,368.87,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,208.49,16.44,234.5,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,80.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,168.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,85.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,78.41,75.93,78.41,270,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,80.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,85.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,450,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,82.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,80.7,1500,,facility
INJ MVASI 10 MG,Q5107,HCPCS,636,RC,,,,outpatient,,,33.26,3.33,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,5258.88,5258.88,5258.88,198,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,24.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,5570.26,5570.26,5570.26,180,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,2633.91,2560.07,7525.25,438,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,24.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,51.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,24.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,61.77,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,25.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,24.53,448,,facility
VIRUS INOCULATION TISSUE,87252,CPT,306,RC,,,,outpatient,,,32.59,3.26,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,26.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,54.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,27.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,26.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,27.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,56.32,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,26.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,26.07,448,,facility
TISSUE CULTURE BONE MARROW,88237,CPT,311,RC,,,,outpatient,,,179.69,17.97,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,127.86,127.86,127.86,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,506.24,506.24,506.24,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,143.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,143.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,148.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,143.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,300.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,152.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,127.86,127.86,127.86,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,143.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,152.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,272.88,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,146.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,143.75,448,,facility
LEGION PNEUMOPHILIA AG IF,87278,CPT,306,RC,,,,outpatient,,,19.5,1.95,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,564.44,564.44,564.44,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,32.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.88,13.88,13.88,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.3,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,15.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,15.6,448,,facility
FIBRINOGEN ACTIVITY,85384,CPT,305,RC,,,,outpatient,,,12.15,1.22,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,8.65,8.65,8.65,24,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,35.38,22.51,262.09,12,percent of total billed charges,,,33.6,,35.38,22.51,154.22,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,154.22,154.22,311.2,1 through 10,percent of total billed charges,,,34.6,,169.83,169.83,169.83,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,9.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,20.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,33.5,33.5,33.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,8.65,8.65,8.65,96,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,9.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.36,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,9.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,9.72,448,,facility
RMVL SUBQ CAR RHYTHM MNTR,33286,CPT,481,RC,,,,outpatient,,,837.95,83.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,677.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,677.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,698.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,677.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1416.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,718.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,677.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,718.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2712,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,691.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,2712,,facility
COCCIDIOIDES ANTIBODY,86635,CPT,302,RC,,,,outpatient,,,14.34,1.43,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,107.18,107.18,107.18,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,23.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.2,10.2,10.2,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.8,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,11.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.47,448,,facility
ENDOVEN THER CHEM ADHES 1ST,36482,CPT,510,RC,,,,outpatient,,,6544.9,654.49,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1027,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1519,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5325.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5325.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5485.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5325.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,11130.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5645.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5325.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5645.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,5432.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,11130.36,,facility
ASSAY TEST FOR BLOOD FECAL,82274,CPT,301,RC,,,,outpatient,,,19.9,1.99,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,33.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,34.37,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,16.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,15.92,448,,facility
SMN1 GENE DOS/DELETION ALYS,81329,CPT,310,RC,,,,outpatient,,,171.25,17.13,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,121.86,121.86,121.86,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,137,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,137,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,141.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,471.5,471.5,471.5,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,300.05,300.05,302.73,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,137,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,286.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,145.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,121.86,121.86,121.86,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,137,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,145.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,239.75,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,139.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,137,448,,facility
HEMOGLOBIN,85018,CPT,305,RC,,,,outpatient,,,2.96,0.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,2.11,2.11,2.11,20,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,17.92,17.92,72.32,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,3.32,3.32,16.52,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,59.66,14.92,94.03,1 through 10,percent of total billed charges,,,33.6,,14.78,14.78,14.92,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,9.41,9.41,37.97,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,4.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,14,14,14,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,2.11,2.11,2.11,57,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.13,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,2.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,2.37,448,,facility
ECHOGRAP TRANS R PROS STUDY,76873,CPT,402,RC,,,,outpatient,,,130.94,13.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,465,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,465,,facility
NSL/SINS NDSC SRG NSL HEMRRG,31238,CPT,450,RC,,,,outpatient,,,2021.43,202.14,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1703.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1703.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1754.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1703.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3560.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1805.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1703.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1805.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1737.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3560.23,,facility
NOONAN SPECTRUM DISORDERS,81442,CPT,310,RC,,,,outpatient,,,2679.5,267.95,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2143.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2143.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2207.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2143.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,4480.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2272.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2143.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2272.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3751.3,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,2186.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,4480.12,,facility
BIOPSY ARM/ELBOW SOFT TISSUE,24066,CPT,361,RC,,,,outpatient,,,3384.19,338.42,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,2779.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2779.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2863.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2779.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,5810.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2946.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2779.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2946.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3821,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,2835.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,5810.16,,facility
KRAS GENE VARIANTS EXON 2,81275,CPT,310,RC,,,,outpatient,,,241.56,24.16,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,193.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,193.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,199.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,193.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,403.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,204.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,193.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,204.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,338.19,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,197.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,193.25,448,,facility
ENCEPHALTIS WEST EQNE ANTBDY,86654,CPT,302,RC,,,,outpatient,,,16.49,1.65,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.49,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.19,448,,facility
CHEMO INTRALESIONAL OVER 7,96406,CPT,331,RC,,,,outpatient,,,255.28,25.53,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,203.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,203.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,209.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,203.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,425.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,215.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,203.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,215.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1603,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,207.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,203.57,1603,,facility
AGENT NOS ASSAY W/OPTIC,87899,CPT,306,RC,,,,outpatient,,,20.09,2.01,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,33.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,14.29,14.29,14.29,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.12,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,16.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,16.07,448,,facility
TOXOPLASMA ANTIBODY IGM,86778,CPT,302,RC,,,,outpatient,,,18.01,1.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.82,12.82,12.82,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,30.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.82,12.82,12.82,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,31.12,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.41,448,,facility
ASSAY OF PROTEIN OTHER,84157,CPT,301,RC,,,,outpatient,,,5,0.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,38.16,28.56,44.88,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,8.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,17.85,17.85,17.85,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.56,3.56,3.56,13,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.93,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,4.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,4,448,,facility
UR ALBUMIN QUANTITATIVE,82043,CPT,301,RC,,,,outpatient,,,7.23,0.72,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.14,5.14,5.14,85,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,38.35,29.5,51.92,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,46.46,26.4,46.46,31,percent of total billed charges,,,33.6,,29.57,16.95,46.6,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,29.57,21.84,29.92,43,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,12.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,163.5,32.5,188.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,13.65,13.65,18.53,1 through 10,percent of total billed charges,,,35,,17.34,17.34,17.34,1 through 10,percent of total billed charges,,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.14,5.14,5.14,290,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.5,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.78,448,,facility
PERQ NL/PL LITHOTRP SMPL<2CM,50080,CPT,361,RC,,,,outpatient,,,10971.76,1097.18,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1268,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1793,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,9059.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9059.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9331.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,9059.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,18935.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,9603.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,9059.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,9603.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10550,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,9241.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,18935.3,,facility
SC STD MYOBACTERIA PROP METH,87190,CPT,306,RC,,,,outpatient,,,9.14,0.91,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,7.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,15.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,7.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,7.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,7.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.79,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,7.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,7.31,448,,facility
SPEECH EVALUATION COMPLEX,70371,CPT,320,RC,,,,outpatient,,,291.84,29.18,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,235.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,477.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,242.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,242.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,232.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,228.36,477.27,,facility
IMMUNOASSAY TUMOR CA 19-9,86301,CPT,302,RC,,,,outpatient,,,26.01,2.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,18.51,18.51,18.51,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,128.41,40.13,163.31,1 through 10,percent of total billed charges,,,33.6,,96.1,96.1,96.1,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,96.1,25.54,96.95,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,20.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,43.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,60.06,60.06,60.06,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,18.51,18.51,18.51,16,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,20.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,44.98,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,21.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,20.81,448,,facility
NDL INSJ W/O NJX 1 OR 2 MUSC,20560,CPT,761,RC,,,,outpatient,,,35.46,3.55,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,27.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,57.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,29.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,27.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,29.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,28.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,27.68,1173,,facility
CT ANGIOGRAPHY HEAD,70496,CPT,350,RC,,,,outpatient,,,218.83,21.88,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,381.77,156.2,381.77,43,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,411,411,411,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,378,378,378,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,875,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1050,,,,,,,case rate,NTE Percentage + Reimbursement Rate 85.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,172.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,1765.34,413.89,3000.03,1 through 10,percent of total billed charges,,,33.6,,1765.34,1765.34,1765.34,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,1765.34,1765.34,3481.26,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,350.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,177.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,2627,2627,2627,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,143.26,143.14,143.26,27,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,177.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1522,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,171.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,167.87,1522,,facility
INJ LUSPATERCEPT-AAMT 0.25MG,J0896,HCPCS,636,RC,,,,outpatient,,,50.85,5.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,43.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,43.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,44.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,43.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,90.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,46.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,43.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,46.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,88.75,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,44.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,43.51,448,,facility
EMERGENCY DEPT VISIT LOW MDM,99283,CPT,450,RC,,,,outpatient,,,339.81,33.98,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,242.94,227.44,245.82,4384,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,895,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1382,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,913,913,1057,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1200,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1500,,,,,,,case rate,NTE Percentage + Reimbursement Rate 85.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,261.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,261.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,269.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,1124.3,643.42,1138.01,187,percent of total billed charges,,,33.6,,669.65,637.73,1138.01,50,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,669.65,637.73,669.65,66,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,261.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,546.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,276.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,996.5,949,996.5,18,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,418.53,255.98,418.53,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,246.57,246.57,246.57,1 through 10,percent of total billed charges,,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,150.22,78.41,246.57,3362,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,261.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,276.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2075,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,266.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,261.25,2075,,facility
MPL GENE COMMON VARIANTS,81338,CPT,310,RC,,,,outpatient,,,187.91,18.79,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,150.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,150.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,154.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,150.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,314.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,159.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,133.72,133.72,133.72,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,150.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,159.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,263.08,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,153.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,150.33,448,,facility
TREAT TOE DISLOCATION,28630,CPT,761,RC,,,,outpatient,,,280.86,28.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,243.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,493.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,240.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,236.08,1173,,facility
HEP B CORE ANTIBODY IGM,86705,CPT,302,RC,,,,outpatient,,,14.71,1.47,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.47,10.47,10.47,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,78.08,78.08,78.08,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,64.15,64.15,64.15,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,41.19,40.99,41.19,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,24.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.47,10.47,10.47,11,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.45,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.77,448,,facility
HEPATIC FUNCTION PANEL,80076,CPT,301,RC,,,,outpatient,,,10.21,1.02,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,17.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.66,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,8.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,8.17,448,,facility
CHANGE URETER STENT PERCUT,50382,CPT,361,RC,,,,outpatient,,,2425.83,242.58,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,2000.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2000.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2060.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2000.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,4181.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2120.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2000.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2120.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9389,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,2040.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,9389,,facility
DRUG TEST DEF 1-7 CLASSES,G0480,HCPCS,301,RC,,,,outpatient,,,143.04,14.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,101.78,101.78,101.78,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,36.32,36.32,36.32,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,114.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,114.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,117.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,104.49,61.49,104.49,27,percent of total billed charges,,,33.6,,61.49,61.49,104.51,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,61.49,47.8,61.49,11,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,114.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,239.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,121.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,91.5,91.5,91.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,101.78,101.78,101.78,280,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,114.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,121.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,200.25,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,116.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,114.43,448,,facility
INTMD RPR S/A/T/EXT 20.1-30,12036,CPT,761,RC,,,,outpatient,,,748,74.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,707.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,707.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,728.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,707.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1478.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,749.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,707.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,749.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,721.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1478.34,,facility
X-RAY EXAM OF HAND,73130,CPT,320,RC,,,,outpatient,,,108.23,10.82,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,85.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,174.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,23.45,23.45,24.14,79,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,84.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,83.29,448,,facility
DNA/RNA DIRECT PROBE,87149,CPT,306,RC,,,,outpatient,,,25.06,2.51,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,20.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,41.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,21.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,20.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,21.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,43.33,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,20.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,20.05,448,,facility
CLTX PROX HUMRL FX W/O MNPJ,23600,CPT,450,RC,,,,outpatient,,,280.86,28.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,243.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,493.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,240.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,236.08,1173,,facility
MOTOR &/ SENS NRVE CNDJ TEST,95905,CPT,922,RC,,,,outpatient,,,474.54,47.45,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,427.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,427.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,440.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,427.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,893.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,453.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,427.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,453.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,478,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,436.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,427.54,893.56,,facility
INJ IVIG PRIVIGEN 500 MG,J1459,HCPCS,636,RC,,,,outpatient,,,60.84,6.08,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,18591.78,18591.78,18591.78,70,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,51.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,51.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,52.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,806.82,806.82,1613.64,81,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,51.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,107.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,54.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,51.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,54.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,105.95,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,52.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,51.22,448,,facility
ASSAY OF PYRUVATE,84210,CPT,301,RC,,,,outpatient,,,18.1,1.81,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,30.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.88,12.88,12.88,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.34,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.48,448,,facility
CREATINE MB FRACTION,82553,CPT,301,RC,,,,outpatient,,,14.44,1.44,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.27,10.27,10.27,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,24.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.96,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,11.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.55,448,,facility
COMPATIBILITY TEST SPIN,86920,CPT,302,RC,,,,outpatient,,,203.43,20.34,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,150.35,150.35,150.35,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,167.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,317.86,317.86,635.71,1 through 10,percent of total billed charges,,,33.6,,343.74,343.74,343.74,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,229.36,218.53,229.36,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,340.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,172.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,1264.2,1264.2,1264.2,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,14.05,14.05,14.05,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,172.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,226.07,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,166.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,163.06,448,,facility
CSTB GENE KNOWN FAMIL VRNT,81190,CPT,310,RC,,,,outpatient,,,231.5,23.15,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,185.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,185.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,190.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,185.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,387.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,196.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,185.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,196.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,324.1,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,188.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,185.2,448,,facility
T CELL ABSOLUTE COUNT,86361,CPT,302,RC,,,,outpatient,,,33.48,3.35,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,23.82,23.82,23.82,46,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,160.48,160.19,463.15,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,143.62,91.39,143.62,24,percent of total billed charges,,,33.6,,143.62,91.39,414.48,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,91.39,91.39,92.04,15,percent of total billed charges,,,34.6,,284.95,284.95,284.95,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,26.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,55.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,28.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,136,135.75,136,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,23.82,23.82,23.82,197,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,26.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,28.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,57.86,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,27.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,26.78,448,,facility
LYME DISEASE ANTIBODY,86617,CPT,302,RC,,,,outpatient,,,19.36,1.94,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,25.26,25.26,25.26,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,32.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.78,13.78,13.78,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,33.48,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,15.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,15.49,448,,facility
EXC TR-EXT B9+MARG 3.1-4 CM,11404,CPT,761,RC,,,,outpatient,,,1930.94,193.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1628.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3303.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1675.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1675.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,1612.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3303.62,,facility
ASSAY OF THIOCYANATE,84430,CPT,301,RC,,,,outpatient,,,14.54,1.45,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,24.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.13,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,11.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.63,448,,facility
SHAVE SKIN LESION 0.5 CM/<,11310,CPT,761,RC,,,,outpatient,,,238.44,23.84,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,197.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,401.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,203.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,203.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,195.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,192.01,448,,facility
FETAL BIOPHYS PROFILE W/NST,76818,CPT,402,RC,,,,outpatient,,,130.94,13.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,465,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,465,,facility
REMOVE LUNG CATHETER,32552,CPT,361,RC,,,,outpatient,,,748.19,74.82,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,600.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,600.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,618.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,697.87,697.87,697.87,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,600.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1254.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,636.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,600.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,636.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2712,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,612.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,2712,,facility
TREAT METACARPAL FRACTURE,26605,CPT,761,RC,,,,outpatient,,,280.86,28.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,243.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,493.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,240.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,236.08,1311,,facility
CONTRAST X-RAY OF KNEE JOINT,73580,CPT,322,RC,,,,outpatient,,,458.03,45.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,333.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,333.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,343.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,333.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,697.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,353.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,333.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,353.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,340.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,333.9,697.85,,facility
BRACHYTX ISODOSE INTERMED,77317,CPT,333,RC,,,,outpatient,,,440.06,44.01,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,358.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,358.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,369.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,358.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,748.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,379.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,358.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,379.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,48815,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,365.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,358.36,48815,,facility
IXABEPILONE INJECTION,J9207,HCPCS,636,RC,,,,outpatient,,,166.46,16.65,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,139.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,139.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,143.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,139.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,292.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,148.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,139.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,148.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,293.32,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,142.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,139.75,448,,facility
CLTX RDL&ULN SHFT FX W/MNPJ,25565,CPT,761,RC,,,,outpatient,,,1914.16,191.42,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1585.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3216.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1631.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1631.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,1569.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3216.38,,facility
CHEMODENERV SALIV GLANDS,64611,CPT,761,RC,,,,outpatient,,,352.75,35.28,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,293.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,293.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,302.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,293.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,613.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,311.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,293.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,311.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,299.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,293.77,1173,,facility
COLLAGEN CROSSLINKS,82523,CPT,301,RC,,,,outpatient,,,23.35,2.34,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,39.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.62,16.62,16.62,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,40.37,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.68,448,,facility
ASSAY OF SEROTONIN,84260,CPT,301,RC,,,,outpatient,,,38.73,3.87,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,31.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,30.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,64.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,32.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,30.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,32.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,66.94,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,31.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,30.98,448,,facility
ALPHA-FETOPROTEIN SERUM,82105,CPT,301,RC,,,,outpatient,,,20.96,2.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,14.92,14.92,14.92,44,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,215.35,215.35,215.35,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,58.61,58.61,192.72,11,percent of total billed charges,,,33.6,,58.61,37.3,122.64,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,37.3,37.3,123.74,15,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,35.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,14.92,14.92,14.92,104,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.24,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,16.77,448,,facility
FXN GENE FULL GENE SEQUENCE,81286,CPT,310,RC,,,,outpatient,,,343.54,34.35,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,274.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,274.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,283.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,274.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,574.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,291.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,274.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,291.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,480.95,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,280.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,274.83,574.39,,facility
NEG PRS WND THR NDME<=50SQCM,97607,CPT,420,RC,,,,outpatient,,,474.9,47.49,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,80,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,390.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,390.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,402.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,390.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,817.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,414.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,390.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,414.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,422,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,398.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,80,817.13,,facility
DRAINAGE OF FINGER ABSCESS,26010,CPT,761,RC,,,,outpatient,,,238.44,23.84,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,197.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,401.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,203.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,203.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,195.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,192.01,448,,facility
EHRLICHIA ANTIBODY,86666,CPT,302,RC,,,,outpatient,,,12.73,1.27,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,7.53,7.53,7.53,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,21.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9.05,9.05,9.05,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.98,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,10.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,10.18,448,,facility
BIOPSY ARM/ELBOW SOFT TISSUE,24065,CPT,361,RC,,,,outpatient,,,1930.94,193.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1628.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3303.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1675.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1675.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3821,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1612.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3821,,facility
NSL/SINS NDSC DX SPHN SINUSC,31235,CPT,761,RC,,,,outpatient,,,2021.43,202.14,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1703.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1703.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1754.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1703.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3560.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1805.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1703.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1805.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,1737.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3560.23,,facility
ASSAY OF VITAMIN B-1,84425,CPT,301,RC,,,,outpatient,,,26.54,2.65,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,18.88,18.88,18.88,41,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,39.83,39.83,39.83,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,35.9,35.64,35.9,1 through 10,percent of total billed charges,,,33.6,,22.88,22.88,22.88,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,22.85,22.85,22.88,16,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,21.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,44.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,18.88,18.88,18.88,118,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,21.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,45.87,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,21.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,21.23,448,,facility
UPPER EXTREMITY STUDY,93930,CPT,921,RC,,,,outpatient,,,291.84,29.18,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,235.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,477.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,242.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,242.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1227,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,232.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,228.36,1227,,facility
ANTINUCLEAR ANTIBODIES (ANA),86039,CPT,302,RC,,,,outpatient,,,13.95,1.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5,5,5,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,11.76,11.76,11.76,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,1.68,1.68,1.68,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,23.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9.93,5,9.93,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.12,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,11.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.16,448,,facility
VIRUS INOCULATION SHELL VIA,87254,CPT,306,RC,,,,outpatient,,,24.45,2.45,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,40.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,20.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,20.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.26,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,19.56,448,,facility
USE PARENCHYMA,76981,CPT,402,RC,,,,outpatient,,,130.94,13.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,402.56,402.56,402.56,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,282.42,282.42,282.42,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,62.56,62.56,62.56,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,465,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,465,,facility
PLASMA 1 DONOR FRZ W/IN 8 HR,P9017,HCPCS,390,RC,,,,outpatient,,,99.95,10,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,85.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,85.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,88.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,830.02,830.02,830.02,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,85.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,178.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,90.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,85.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,90.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,107,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,87.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,85.56,448,,facility
CYTOG ALYS CHRML ABNR SNPCGH,81229,CPT,310,RC,,,,outpatient,,,1450,145,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,1031.8,1031.8,1031.8,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1160,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1160,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1194.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,1457.28,1457.28,1457.28,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,2671.54,2671.54,2671.54,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1160,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,2424.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1229.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,1031.8,1031.8,1031.8,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1160,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1229.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2030,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1183.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,2424.4,,facility
RBC LEUKOREDUCED IRRADIATED,P9040,HCPCS,390,RC,,,,outpatient,,,315.6,31.56,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,235.95,235.95,264.11,49,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,1502.72,1502.72,3005.44,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,264.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,264.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,272.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,1239.74,788.93,2479.49,1 through 10,percent of total billed charges,,,33.6,,788.93,788.93,1340.71,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,894.59,852.32,894.59,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,264.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,551.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,279.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,493.08,493.08,493.08,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,169.4,169.4,169.4,35,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,264.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,279.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,107,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,269.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,107,551.99,,facility
COLONOSCOPY W/FB REMOVAL,45379,CPT,750,RC,,,,outpatient,,,1405.45,140.55,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1179.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,1882.94,1882.94,1882.94,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,2393.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1213.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1213.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3821,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1168.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3821,,facility
GENETIC TSTG SEVERE INH COND,81443,CPT,310,RC,,,,outpatient,,,3060.7,306.07,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2448.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2448.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2522.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2448.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,5117.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2595.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2448.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2595.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4284.98,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,2497.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,5117.49,,facility
PARTICLE AGGLUT ANTBDY SCRN,86403,CPT,302,RC,,,,outpatient,,,14.43,1.44,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,154.18,154.18,154.18,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,24.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.26,10.26,10.26,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.02,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,11.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.54,448,,facility
NDL EMG LMTD STD MUSC 1 XTR,95870,CPT,922,RC,,,,outpatient,,,152.14,15.21,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,131.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,266.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,134.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,134.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,478,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,129.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,127.33,478,,facility
X-RAY EXAM OF ANKLE,73600,CPT,320,RC,,,,outpatient,,,108.23,10.82,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,85.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,174.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.68,19.68,20.53,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,84.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,83.29,448,,facility
INCISION OF LIP FOLD,40806,CPT,361,RC,,,,outpatient,,,655.29,65.53,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,516.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,516.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,531.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,516.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1078.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,547.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,516.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,547.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2440,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,526.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,2440,,facility
GOSERELIN ACETATE IMPLANT,J9202,HCPCS,636,RC,,,,outpatient,,,824.42,82.44,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,1594.77,1594.77,1594.77,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,1427.18,1427.18,1427.18,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1511.58,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,1511.58,,facility
CANDIDA DNA DIR PROBE,87480,CPT,306,RC,,,,outpatient,,,25.06,2.51,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,20.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,41.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,21.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,20.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,21.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,43.33,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,20.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,20.05,448,,facility
TREAT FOOT DISLOCATION,28540,CPT,450,RC,,,,outpatient,,,280.86,28.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,243.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,493.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,240.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,236.08,1173,,facility
NEG PRS WND THER DME<=50SQCM,97605,CPT,761,RC,,,,outpatient,,,238.44,23.84,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,197.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,401.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,203.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,203.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,195.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,192.01,448,,facility
ASSAY PH BODY FLUID NOS,83986,CPT,301,RC,,,,outpatient,,,4.48,0.45,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.18,3.18,3.18,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,75.43,75.43,75.43,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,7.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.18,3.18,3.18,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.74,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,3.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,3.58,448,,facility
GENOME SEQUENCE ANALYSIS,81426,CPT,310,RC,,,,outpatient,,,3387.44,338.74,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2709.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2709.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2791.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2709.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,5663.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2872.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2709.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2872.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4742.41,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,2764.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,5663.8,,facility
CLEARANCE OF AIRWAYS,31720,CPT,410,RC,,,,inpatient,,,254.03,25.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Short Stay Lesser of + Days Threshold 1.00 + Stoploss First Dollar + Reimbursement Rate 57.00 + Basic Per Diem + Fixed Rate 5000.00 + Fixed Amount 157464.00,,,,0,other,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,Short Stay Lesser of + Days Threshold 1.00 + Stoploss First Dollar + Reimbursement Rate 72.00 + Basic Per Diem + Fixed Rate 10000.00 + Fixed Amount 56687.00,,,,0,other,NTE Percentage + Reimbursement Rate 85.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,47.3,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,facility
LACTATE (LD) (LDH) ENZYME,83615,CPT,301,RC,,,,outpatient,,,7.55,0.76,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.37,5.37,5.37,60,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,38.94,38.94,38.94,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,34.85,11.09,34.85,38,percent of total billed charges,,,33.6,,22.18,22.18,22.18,46,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,20.95,20.95,22.18,22,percent of total billed charges,,,34.6,,23.96,20.95,25.15,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,12.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,13.86,13.86,13.86,17,percent of total billed charges,,,35,,27.5,27.5,27.5,1 through 10,percent of total billed charges,,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.37,5.37,5.37,235,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.04,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,6.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,6.04,448,,facility
BLOOD PLATELET AGGREGATION,85576,CPT,305,RC,,,,outpatient,,,31.14,3.11,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,22.16,22.16,22.16,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,70.56,70.56,70.56,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,24.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,52.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,26.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,22.16,22.16,22.16,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,24.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,26.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,46.41,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,25.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,24.91,448,,facility
WHOLE MITOCHONDRIAL GENOME,81465,CPT,310,RC,,,,outpatient,,,1170,117,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,936,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,936,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,964.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,936,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1956.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,992.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,936,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,992.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1638,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,954.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1956.24,,facility
PSYCH DIAG EVAL W/MED SRVCS,90792,CPT,900,RC,,,,outpatient,,,189.89,18.99,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,140.97,140.97,169.87,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,169.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,169.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,174.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,293.04,293.04,293.04,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,169.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,355.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,180.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,169.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,180.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1372,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,173.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,169.87,1372,,professional
DIALYSIS ONE EVALUATION,90945,CPT,851,RC,,,,outpatient,,,527.5,52.75,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,399.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,399.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,411.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,399.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,834.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,423.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,399.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,423.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2057,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,407.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,399.34,2057,,facility
VRT FRACTURE ASSMT VIA DXA,77086,CPT,320,RC,,,,outpatient,,,108.23,10.82,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,85.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,174.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,84.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,83.29,448,,facility
BLEPHAROTOMY DRG ABSC EYELID,67700,CPT,361,RC,,,,outpatient,,,346.95,34.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,303.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,303.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,312.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,303.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,634.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,322,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,303.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,322,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2440,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,309.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,303.77,2440,,facility
REMOTE 30 DAY ECG TECH SUPP,93229,CPT,732,RC,,,,outpatient,,,373.83,37.38,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,357.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,357.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,367.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,357.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,746.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,378.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,357.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,378.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,725,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,364.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,357.13,746.4,,facility
WASHED RED BLOOD CELLS UNIT,P9022,HCPCS,390,RC,,,,outpatient,,,496.4,49.64,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,366.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,366.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,377.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,366.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,766.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,388.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,366.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,388.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,107,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,374.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,107,766.55,,facility
BRONCH EBUS SAMPLNG 1/2 NODE,31652,CPT,361,RC,,,,outpatient,,,4460.06,446.01,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,3568.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3568.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3675.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3568.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,7457.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3782.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3568.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3782.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9389,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,3639.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,9389,,facility
X-RAY EXAM OF MASTOIDS,70130,CPT,320,RC,,,,outpatient,,,130.94,13.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,448,,facility
CLTX STRNCLAV DISLC W/MNPJ,23525,CPT,450,RC,,,,outpatient,,,280.86,28.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,243.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,493.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,240.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,236.08,1173,,facility
CT LOWER EXTREMITY W/DYE,73701,CPT,352,RC,,,,outpatient,,,218.83,21.88,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,403,,,,,,,case rate,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,371,,,,,,,case rate,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,875,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1050,,,,,,,case rate,NTE Percentage + Reimbursement Rate 85.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,172.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,350.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,177.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,92.78,92.78,185.56,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,177.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1522,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,171.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,167.87,1522,,facility
VITAMIN D 25 HYDROXY,82306,CPT,301,RC,,,,outpatient,,,37,3.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,26.33,26.33,26.33,345,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,123.9,123.9,399.43,17,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,110.88,70.56,357.46,103,percent of total billed charges,,,33.6,,71.19,70.56,227.47,16,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,70.56,70.56,227.47,175,percent of total billed charges,,,34.6,,257.94,257.94,257.94,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,29.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,61.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,31.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,105,105,338.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,142.17,44.1,142.17,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,26.33,26.33,26.33,1001,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,29.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,31.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,63.96,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,30.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,29.6,448,,facility
APPLICATION CAST FINGER,29086,CPT,450,RC,,,,outpatient,,,187.66,18.77,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,155.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,155.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,160.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,155.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,325.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,164.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,155.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,164.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,158.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,155.52,448,,facility
ENTEROVIRUS PROBE&REVRS TRNS,87498,CPT,306,RC,,,,outpatient,,,43.86,4.39,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
EXERCISE TST BRNCSPSM W/ECG,94617,CPT,460,RC,,,,outpatient,,,152.14,15.21,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,113.1,113.1,122.61,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,131.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,266.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,134.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,47.15,47.15,47.15,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,134.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,611,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,129.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,127.33,611,,facility
LYMPHOCYTE TRANSFORMATION,86353,CPT,302,RC,,,,outpatient,,,61.29,6.13,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,49.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,49.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,50.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,49.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,102.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,51.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,49.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,51.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,105.93,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,50.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,49.03,448,,facility
EXCISE LIP OR CHEEK FOLD,40819,CPT,761,RC,,,,outpatient,,,1816.31,181.63,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1484.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1484.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1529.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1484.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3103.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1574.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1484.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1574.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,1514.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3103.57,,facility
HEPATITIS DELTA AGENT ANTBDY,86692,CPT,302,RC,,,,outpatient,,,21.45,2.15,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,35.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,37.08,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.16,448,,facility
MECP2 GENE FULL SEQ,81302,CPT,310,RC,,,,outpatient,,,659.84,65.98,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,527.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,527.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,543.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,527.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1103.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,559.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,527.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,559.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,923.77,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,538.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1103.25,,facility
SC STD DISK METHOD PER PLATE,87184,CPT,306,RC,,,,outpatient,,,9.35,0.94,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,7.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,15.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,7.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,6.65,6.65,6.65,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,7.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,7.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.89,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,7.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,7.48,448,,facility
INSULIN ANTIBODIES,86337,CPT,302,RC,,,,outpatient,,,26.76,2.68,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.04,19.04,19.04,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,34.85,34.85,34.85,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,21.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,44.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.04,19.04,19.04,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,21.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,46.25,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,21.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,21.41,448,,facility
DNA/RNA AMPLIFIED PROBE,87150,CPT,306,RC,,,,outpatient,,,43.86,4.39,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
TREATMENT OF ANKLE FRACTURE,27818,CPT,761,RC,,,,outpatient,,,1914.16,191.42,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1585.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3216.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1631.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1631.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,1569.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3216.38,,facility
CYTOPATH CELL ENHANCE TECH,88112,CPT,311,RC,,,,outpatient,,,64.54,6.45,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,46.88,46,49.87,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,56.96,56.96,56.96,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,49.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,49.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,51.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,120.62,29.9,189.55,1 through 10,percent of total billed charges,,,33.6,,29.9,29.9,120.62,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,49.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,104.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,52.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,75.39,75.39,75.39,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,33.17,33.17,34.41,11,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,49.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,52.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,78.23,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,50.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,49.87,448,,facility
ASSAY NEPHELOMETRY NOT SPEC,83883,CPT,301,RC,,,,outpatient,,,17,1.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.1,12.1,12.1,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,173.18,51.22,173.18,1 through 10,percent of total billed charges,,,33.6,,31.58,31.58,31.58,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,31.58,31.53,110.21,11,percent of total billed charges,,,34.6,,119.06,117.35,124.97,24,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,28.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.1,12.1,12.1,29,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.38,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.6,448,,facility
CLOSED TX VERT FX W/O MANJ,22310,CPT,761,RC,,,,outpatient,,,280.86,28.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,243.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,493.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,240.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,236.08,1173,,facility
ENDOSCOPY OF BOWEL POUCH,44385,CPT,750,RC,,,,outpatient,,,1088.51,108.85,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,890.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,890.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,916.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,890.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1860.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,943.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,811.89,0.28,837.43,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,890.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,943.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3821,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,907.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3821,,facility
ASSAY OF HISTAMINE,83088,CPT,301,RC,,,,outpatient,,,36.91,3.69,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,29.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,61.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,31.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,26.27,26.27,26.27,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,29.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,31.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,63.81,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,30.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,29.53,448,,facility
CHEMO EXTEND IV INFUS W/PUMP,G0498,HCPCS,335,RC,,,,outpatient,,,403.35,40.34,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,291.03,291.03,315.51,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,824.32,824.32,824.32,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,316.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,316.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,325.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,316.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,660.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,335.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,316.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,335.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1603,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,322.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,316.12,1603,,facility
MLH1 GENE FULL SEQ,81292,CPT,310,RC,,,,outpatient,,,844.25,84.43,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,675.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,675.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,695.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,675.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1411.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,715.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,675.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,715.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1181.95,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,688.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1411.59,,facility
REMOVE URETER STENT PERCUT,50384,CPT,761,RC,,,,outpatient,,,2425.83,242.58,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2000.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2000.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2060.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2000.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,4181.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2120.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2000.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2120.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,2040.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,4181.3,,facility
REPAIR FINGER TENDON,26418,CPT,761,RC,,,,outpatient,,,1914.16,191.42,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1268,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1793,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1585.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3216.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1631.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1631.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,1569.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3216.38,,facility
LAPAROSCOPY REMOVE ADNEXA,58661,CPT,360,RC,,,,outpatient,,,6871.99,687.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1445,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,2070,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,5785.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5785.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5959.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5785.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,12092.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6133.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5195.58,5195.58,5361.58,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5785.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6133.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11062,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5901.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,12092.57,,facility
DRAINAGE OF MOUTH LESION,40801,CPT,450,RC,,,,outpatient,,,655.29,65.53,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,516.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,516.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,531.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,516.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1078.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,547.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,516.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,547.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,526.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1311,,facility
PLATELET PHERES LEUKOREDUCED,P9035,HCPCS,390,RC,,,,outpatient,,,590.41,59.04,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,509.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,509.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,524.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,509.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1063.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,539.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,509.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,539.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,107,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,519.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,107,1063.98,,facility
AIRWAY INHALATION TREATMENT,94640,CPT,410,RC,,,,inpatient,,,254.03,25.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,178.46,178.46,209.58,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,73,,426.32,426.32,426.32,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Short Stay Lesser of + Days Threshold 1.00 + Stoploss First Dollar + Reimbursement Rate 57.00 + Basic Per Diem + Fixed Rate 5000.00 + Fixed Amount 157464.00,,,,0,other,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,Short Stay Lesser of + Days Threshold 1.00 + Stoploss First Dollar + Reimbursement Rate 72.00 + Basic Per Diem + Fixed Rate 10000.00 + Fixed Amount 56687.00,,,,0,other,NTE Percentage + Reimbursement Rate 85.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,33.6,,196.22,181.53,196.22,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,196.22,152.21,196.22,1 through 10,percent of total billed charges,,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,47.3,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,50,,292,292,1168,1 through 10,percent of total billed charges,,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,355.93,355.93,1067.79,46,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,6.45,6.45,6.64,486,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,193.47,193.47,193.47,1 through 10,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,197.34,197.34,197.34,1 through 10,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,facility
CONTROL OF NOSEBLEED,30903,CPT,761,RC,,,,outpatient,,,152.14,15.21,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,131.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,266.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,134.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,134.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,129.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,127.33,1173,,facility
FOREHEAD FLAP W/VASC PEDICLE,15731,CPT,761,RC,,,,outpatient,,,4272.83,427.28,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1027,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1519,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3391.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3391.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3493.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3391.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,7088.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3595.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3391.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3595.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,3459.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,7088.34,,facility
PALB2 GENE FULL GENE SEQ,81307,CPT,310,RC,,,,outpatient,,,845.63,84.56,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,676.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,676.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,696.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,676.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1413.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,717.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,676.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,717.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,495.04,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,690.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1413.88,,facility
TOXOPLASMA ANTIBODY,86777,CPT,302,RC,,,,outpatient,,,17.99,1.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.8,12.8,12.8,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,64.42,64.42,64.42,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,30.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.8,12.8,12.8,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,31.1,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.39,448,,facility
ENTAMOEB HIST GROUP AG IA,87337,CPT,306,RC,,,,outpatient,,,14.98,1.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.9,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.98,448,,facility
WBC ANTIBODY IDENTIFICATION,86021,CPT,302,RC,,,,outpatient,,,18.81,1.88,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.39,13.39,13.39,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,20.59,13.1,38.54,1 through 10,percent of total billed charges,,,33.6,,134.11,134.11,134.11,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,13.1,13.1,13.1,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,31.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.39,13.39,13.39,23,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.53,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,15.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,15.05,448,,facility
HEPARIN ASSAY,85520,CPT,305,RC,,,,outpatient,,,16.36,1.64,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.64,11.64,11.64,13,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,131.71,49.68,223.83,17,percent of total billed charges,,,33.6,,131.71,131.71,131.71,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,131.76,131.71,132.89,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,196,196,196,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,82.32,82.32,82.32,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.64,11.64,11.64,91,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.28,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.09,448,,facility
UNLISTED PX TONGUE FLR MOUTH,41599,CPT,761,RC,,,,outpatient,,,290.91,29.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,226.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,226.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,233.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,226.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,473.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,240.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,226.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,240.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,231.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,226.68,473.76,,facility
ASSAY OF OSTEOCALCIN,83937,CPT,301,RC,,,,outpatient,,,37.31,3.73,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,29.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,62.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,31.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,26.55,26.55,26.55,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,29.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,31.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,64.49,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,30.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,29.85,448,,facility
TRICHOMONAS VAGINALIS AMPLIF,87661,CPT,306,RC,,,,outpatient,,,43.86,4.39,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,57,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,127.44,127.44,127.44,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,114.05,72.58,123.34,1 through 10,percent of total billed charges,,,33.6,,28.9,28.9,114.05,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,72.58,28.9,73.22,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,91,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
CELL CRYOPRESERVE/STORAGE,88240,CPT,310,RC,,,,outpatient,,,16.34,1.63,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.63,11.63,11.63,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.87,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.07,448,,facility
DRUG TEST PRSMV INSTRMNT,80306,CPT,301,RC,,,,outpatient,,,21.43,2.14,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.25,15.25,15.25,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,42.83,25.2,239.25,1 through 10,percent of total billed charges,,,33.6,,42.83,42.83,42.83,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,25.2,25.2,25.2,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,35.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.25,15.25,15.25,61,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,31.43,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.14,448,,facility
PMS2 GENE DUP/DELET VARIANTS,81319,CPT,310,RC,,,,outpatient,,,254.38,25.44,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,203.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,203.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,209.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,203.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,425.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,215.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,203.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,215.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,356.13,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,207.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,203.5,448,,facility
BIOPSY OF TONGUE,41105,CPT,761,RC,,,,outpatient,,,3834.53,383.45,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,2845.48,2845.48,2845.48,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3173.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3173.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3268.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3173.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,6631.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3363.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3173.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3363.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,3236.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,6631.76,,facility
POLYSOM <6 YRS 4/> PARAMTRS,95782,CPT,920,RC,,,,outpatient,,,1245.23,124.52,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,892.66,758.08,967.76,73,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,8709.76,8709.76,8709.76,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,8029.31,8029.31,8029.31,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,821.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,821.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,846.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,7185.55,7185.55,7185.55,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,4011.73,4011.73,4572.62,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,821.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1717.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,871.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,688.53,688.53,714.45,66,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,821.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,871.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,422,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,838.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,422,1717.69,,facility
CHEMO IV PUSH ADDL DRUG,96411,CPT,331,RC,,,,outpatient,,,83.9,8.39,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,62.45,58.46,119.62,203,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,393.6,362.85,393.6,22,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,68.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,68.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,70.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,324.72,208.49,324.72,1 through 10,percent of total billed charges,,,33.6,,206.64,206.64,206.64,16,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,206.64,206.64,208.49,19,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,68.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,144.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,73.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,63.38,63.38,126.76,99,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,68.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,73.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1603,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,70.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,68.91,1603,,facility
PROTOZOA ANTIBODY NOS,86753,CPT,302,RC,,,,outpatient,,,15.49,1.55,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.02,11.02,11.02,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,98.11,98.11,154.18,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,96.77,32.38,106,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.02,11.02,11.02,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.76,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.39,448,,facility
MRI JNT OF LWR EXTRE W/O DYE,73721,CPT,610,RC,,,,outpatient,,,291.84,29.18,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,786,,,,,,,case rate,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,728,,,,,,,case rate,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1025,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1350,,,,,,,case rate,NTE Percentage + Reimbursement Rate 85.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,235.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,477.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,242.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,242.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2407,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,232.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,228.36,2407,,facility
I&D VULVA/PERINEAL ABSCESS,56405,CPT,761,RC,,,,outpatient,,,382.08,38.21,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,291.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,291.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,300.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,291.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,609.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,309.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,291.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,309.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,297.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,291.64,1311,,facility
C-REACTIVE PROTEIN HS,86141,CPT,302,RC,,,,outpatient,,,16.19,1.62,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.52,11.52,11.52,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,35.38,35.38,35.38,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,22.51,22.51,22.54,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.52,11.52,11.52,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.97,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.95,448,,facility
ASSAY OF SOMATOSTATIN,84307,CPT,301,RC,,,,outpatient,,,22.85,2.29,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,39.48,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.28,448,,facility
ALANINE AMINO (ALT) (SGPT),84460,CPT,301,RC,,,,outpatient,,,6.63,0.66,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.71,4.71,4.71,14,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,391,391,391,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,223.26,61.13,223.26,47,percent of total billed charges,,,33.6,,131.38,131.38,223.26,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,131.38,20.5,132.55,20,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,11.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,195.5,195.5,195.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.71,4.71,4.71,309,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.45,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.3,448,,facility
MRI ORBIT/FACE/NECK W/O DYE,70540,CPT,611,RC,,,,outpatient,,,291.84,29.18,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,786,,,,,,,case rate,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,728,,,,,,,case rate,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1025,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1350,,,,,,,case rate,NTE Percentage + Reimbursement Rate 85.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,235.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,477.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,242.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,3617.5,3617.5,3617.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,242.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2407,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,232.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,228.36,2407,,facility
FAMILY PSYTX W/O PT 50 MIN,90846,CPT,916,RC,,,,outpatient,,,189.89,18.99,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,169.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,169.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,174.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,169.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,355.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,180.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,169.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,180.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,173.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,169.87,448,,professional
ASSAY OF CK (CPK),82550,CPT,301,RC,,,,outpatient,,,8.14,0.81,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.79,5.79,5.79,26,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,19.47,19.47,19.47,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,54.38,17.42,58.81,37,percent of total billed charges,,,33.6,,34.61,32.04,58.81,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,34.61,11.02,34.62,11,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,13.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,51.5,51.5,51.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.79,5.79,5.79,239,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.07,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,6.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,6.51,448,,facility
EXC TR-EXT B9+MARG >4.0 CM,11406,CPT,761,RC,,,,outpatient,,,1930.94,193.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,1421.6,1421.6,1421.6,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1628.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3303.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1675.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,1442.85,1442.85,1442.85,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1675.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,1612.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3303.62,,facility
ASSAY OF COPPER,82525,CPT,301,RC,,,,outpatient,,,15.51,1.55,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.04,11.04,11.04,18,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,35.64,22.85,35.9,1 through 10,percent of total billed charges,,,33.6,,80.64,80.64,80.64,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,22.85,19.49,22.85,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,50.4,50.4,50.4,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.04,11.04,11.04,37,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.81,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.41,448,,facility
CT ANGIO HRT W/3D IMAGE,75574,CPT,350,RC,,,,outpatient,,,218.83,21.88,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,411,411,411,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,875,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1050,,,,,,,case rate,NTE Percentage + Reimbursement Rate 85.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,333.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,333.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,343.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,313.1,259.06,407.09,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,259.06,259.06,259.06,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,333.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,697.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,353.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,333.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,353.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1522,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,340.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,333.9,1522,,facility
APC GENE KNOWN FAM VARIANTS,81202,CPT,310,RC,,,,outpatient,,,350,35,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,280,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,280,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,288.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,280,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,585.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,296.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,280,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,296.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,490,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,285.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,280,585.2,,facility
HGB METHEMOGLOBIN QUAN,83050,CPT,301,RC,,,,outpatient,,,10.25,1.03,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,17.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.84,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,8.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,8.2,448,,facility
TELETHX ISODOSE PLAN SIMPLE,77306,CPT,333,RC,,,,outpatient,,,440.06,44.01,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,358.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,358.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,369.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,358.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,748.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,379.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,358.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,379.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,48815,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,365.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,358.36,48815,,facility
CLTX TRNS-SCPHPRLNR FX MNPJ,25680,CPT,450,RC,,,,outpatient,,,280.86,28.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,243.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,493.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,240.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,236.08,1311,,facility
CHEMILUMINESCENT ASSAY,82397,CPT,301,RC,,,,outpatient,,,17.65,1.77,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.56,12.56,12.56,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,22.85,22.85,22.85,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,29.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.56,12.56,12.56,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.5,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.12,448,,facility
WOUND(S) CARE NON-SELECTIVE,97602,CPT,420,RC,,,,outpatient,,,238.44,23.84,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,80,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,192.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,192.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,198.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,192.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,403.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,204.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,23.64,23.64,23.64,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,192.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,204.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,422,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,196.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,80,448,,facility
SIGMOIDOSCOPY W/FB REMOVAL,45332,CPT,750,RC,,,,outpatient,,,1405.45,140.55,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,993.96,993.96,1077.58,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1179.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,2393.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1213.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1213.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3821,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1168.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3821,,facility
HYDRATE IV INFUSION ADD-ON,96361,CPT,260,RC,,,,outpatient,,,56.58,5.66,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,41.09,37.9,205.45,609,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,238.08,183.04,238.08,28,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,219.48,219.48,438.96,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,44.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,44.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,46.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,196.42,124.99,196.42,60,percent of total billed charges,,,33.6,,124.99,124.99,249.98,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,124.99,96.95,124.99,15,percent of total billed charges,,,34.6,,137.64,137.64,137.64,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,44.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,93.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,47.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,186,186,186,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,78.12,78.12,78.12,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,82.18,41.09,493.08,1324,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,44.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,47.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,427,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,45.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,44.82,448,,facility
REPLACE G/C TUBE PERC,49450,CPT,361,RC,,,,outpatient,,,1079.61,107.96,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,822.62,822.62,822.62,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,868.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,868.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,894.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,868.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1814.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,920.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,868.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,920.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3821,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,885.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3821,,facility
X-RAY EXAM OF ELBOW,73070,CPT,320,RC,,,,outpatient,,,108.23,10.82,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,85.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,174.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,17.25,17.25,17.75,92,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,84.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,83.29,448,,facility
US EXAM PELVIC LIMITED,76857,CPT,402,RC,,,,outpatient,,,130.94,13.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,93.3,92.3,100.06,25,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,566.4,51.66,566.4,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,401.79,401.79,401.79,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,467.28,297.36,505.34,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,297.36,230.86,297.36,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,442.5,442.5,442.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,21.56,21.56,21.91,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,465,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,465,,facility
EXT ECG>7D<15D RECORDING,93246,CPT,730,RC,,,,outpatient,,,47.76,4.78,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,34.44,34.44,34.44,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,128,128,128,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,118,118,118,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,67.2,67.2,67.2,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,67.2,67.2,67.2,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,74.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9.42,9.42,9.42,14,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,389,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,36.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.74,448,,facility
X-RAY EXAM RIBS BIL 3 VIEWS,71110,CPT,320,RC,,,,outpatient,,,130.94,13.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,448,,facility
HEPATITIS B DNA AMP PROBE,87516,CPT,306,RC,,,,outpatient,,,43.86,4.39,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
TRAUMA RESPONS W/HOSP CRITI,G0390,HCPCS,681,RC,,,,outpatient,,,1630.59,163.06,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1281.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1281.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1320.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,75,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1281.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,2679.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,70.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1358.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1281.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1358.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26691,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1307.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,26691,,facility
ASSAY OF URINE CHLORIDE,82436,CPT,301,RC,,,,outpatient,,,7.19,0.72,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.11,5.11,5.11,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,91.39,91.39,92.21,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,12.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,24.5,24.5,136,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.11,5.11,5.11,20,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.87,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.75,448,,facility
NJX AA&/STRD TRIGEMINAL NRV,64400,CPT,761,RC,,,,outpatient,,,352.75,35.28,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,135.49,129.5,280.79,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,293.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,293.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,302.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,293.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,613.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,311.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,293.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,311.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,299.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,293.77,1173,,facility
IRRIGATION OF BLADDER,51700,CPT,761,RC,,,,outpatient,,,294.35,29.44,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,239.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,239.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,246.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,278.54,278.54,278.54,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,239.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,499.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,253.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,239.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,253.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,243.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,239.12,1173,,facility
APC GENE DUP/DELET VARIANTS,81203,CPT,310,RC,,,,outpatient,,,250,25,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,200,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,200,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,206,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,200,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,418,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,212,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,200,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,212,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,350,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,204,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,200,448,,facility
HEP B CORE ANTIBODY TOTAL,86704,CPT,302,RC,,,,outpatient,,,15.06,1.51,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.72,10.72,10.72,67,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,71.68,71.68,83.84,35,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,66.08,66.08,66.08,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,59.14,37.63,59.14,29,percent of total billed charges,,,33.6,,59.14,37.63,59.14,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,37.63,37.63,37.97,41,percent of total billed charges,,,34.6,,38.48,13.53,47.55,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,56,56,56,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.72,10.72,10.72,161,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.04,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.05,448,,facility
CLOT FACTOR IX PTC/CHRSTMAS,85250,CPT,305,RC,,,,outpatient,,,23.8,2.38,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.94,16.94,16.94,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,76.03,48.38,76.03,1 through 10,percent of total billed charges,,,33.6,,48.38,48.38,48.38,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,39.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,20.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,72,72,72,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.94,16.94,16.94,24,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,20.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,41.14,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,19.04,448,,facility
ANOSCOPY AND BIOPSY,46606,CPT,750,RC,,,,outpatient,,,1405.45,140.55,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1179.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,2393.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1213.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1213.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3821,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1168.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3821,,facility
LARYNGOSCOPE W/VC INJ,31570,CPT,750,RC,,,,outpatient,,,4460.06,446.01,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,3568.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3568.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3675.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3568.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,7457.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3782.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3568.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3782.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3821,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,3639.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,7457.62,,facility
X-RAY EXAM THORAC SPINE 2VWS,72070,CPT,320,RC,,,,outpatient,,,130.94,13.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,622.45,622.45,622.45,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,354.48,354.48,602.4,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,354.48,354.48,354.48,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,18.87,18.87,19.41,15,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,448,,facility
EXOME SEQUENCE ANALYSIS,81415,CPT,306,RC,,,,outpatient,,,5975,597.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4780,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4780,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4923.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4780,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,9990.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5066.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4780,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5066.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8365,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,4875.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,9990.2,,facility
DUP-SCAN HEMO COMPL BI STD,93985,CPT,921,RC,,,,outpatient,,,291.84,29.18,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,235.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,477.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,242.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,242.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1227,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,232.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,228.36,1227,,facility
ASSAY OF CPK IN BLOOD,82552,CPT,301,RC,,,,outpatient,,,16.74,1.67,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.93,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.39,448,,facility
CT NECK SPINE W/O DYE,72125,CPT,352,RC,,,,outpatient,,,130.94,13.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,93.3,92.3,197.02,18,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,403,,,,,,,case rate,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,371,,,,,,,case rate,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,875,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1050,,,,,,,case rate,NTE Percentage + Reimbursement Rate 85.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,2995.47,1762.66,2995.47,33,percent of total billed charges,,,33.6,,1762.66,1762.66,2995.47,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,1762.66,1762.66,1778.39,15,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,69.06,69.06,72.18,184,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1522,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,1522,,facility
WEDGE EXCISION SKN NAIL FOLD,11765,CPT,761,RC,,,,outpatient,,,474.9,47.49,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,400.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,813.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,412.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,412.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,396.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,389.05,1173,,facility
TREATMENT OF FIBULA FRACTURE,27781,CPT,450,RC,,,,outpatient,,,1914.16,191.42,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1585.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3216.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1631.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1631.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1569.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3216.38,,facility
MOG-IGG1 ANTB FLO CYTMTRY EA,86363,CPT,302,RC,,,,outpatient,,,47.16,4.72,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,33.56,33.56,33.56,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,37.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,37.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,449.23,449.23,705.94,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,453.24,453.24,453.24,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,78.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,39.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,33.56,33.56,33.56,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,39.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.09,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,38.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,21.09,448,,facility
NJX AA&/STRD NTRCOST NRV 1,64420,CPT,361,RC,,,,outpatient,,,823.63,82.36,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,675.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,675.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,695.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,675.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1411.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,716.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,675.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,716.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2712,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,689.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,2712,,facility
BCR/ABL1 GENE MINOR BP,81207,CPT,310,RC,,,,outpatient,,,181.05,18.11,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,144.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,144.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,149.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,144.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,302.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,153.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,144.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,153.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,312.92,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,147.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,144.84,448,,facility
COMPLEMENT/FUNCTION ACTIVITY,86161,CPT,302,RC,,,,outpatient,,,15,1.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.92,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12,448,,facility
CT HRT W/O DYE W/CA TEST,75571,CPT,350,RC,,,,outpatient,,,108.23,10.82,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,403,,,,,,,case rate,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,371,,,,,,,case rate,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,875,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1050,,,,,,,case rate,NTE Percentage + Reimbursement Rate 85.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,85.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,397.58,397.58,397.58,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,174.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1522,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,84.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,83.29,1522,,facility
CULTURE TYPE IMMUNOFLUORESC,87140,CPT,306,RC,,,,outpatient,,,6.96,0.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,11.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.04,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.57,448,,facility
VIT D 1 25-DIHYDROXY,82652,CPT,301,RC,,,,outpatient,,,48.13,4.81,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,34.25,34.25,34.25,16,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,30.68,30.68,30.68,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,39.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,41.71,17.47,46.99,1 through 10,percent of total billed charges,,,33.6,,17.47,17.47,29.9,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,26.78,26.54,26.78,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,38.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,80.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,40.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,39.5,39.5,39.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,34.25,34.25,34.25,35,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,38.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,40.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.18,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,39.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,38.5,448,,facility
TREATMENT OF THIGH FRACTURE,27510,CPT,761,RC,,,,outpatient,,,1914.16,191.42,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1585.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3216.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1631.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1631.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,1569.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3216.38,,facility
CHORIONIC GONADOTROPIN ASSAY,84703,CPT,301,RC,,,,outpatient,,,9.4,0.94,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,6.69,6.69,6.69,19,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,23.68,23.68,102.4,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,91.36,19.54,91.36,38,percent of total billed charges,,,33.6,,53.76,49.73,91.36,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,53.76,41.7,53.76,24,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,7.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,15.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,7.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,6.69,6.69,6.69,323,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,7.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,7.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.26,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,7.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,7.52,448,,facility
PLMT NEPHROSTOMY CATHETER,50432,CPT,361,RC,,,,outpatient,,,2425.83,242.58,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,2000.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2000.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2060.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2000.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,4181.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2120.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2000.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2120.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9389,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,2040.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,9389,,facility
DILATION AND CURETTAGE,58120,CPT,761,RC,,,,outpatient,,,3723.46,372.35,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3098.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3098.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3191.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3098.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,6475.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3284,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3098.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3284,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,3160.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,6475.05,,facility
POLYSOM 6/>YRS CPAP 4/> PARM,95811,CPT,740,RC,,,,outpatient,,,1245.23,124.52,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,892.66,758.08,892.66,13,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,7232,7232,7232,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,821.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,821.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,846.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,5966.4,5966.4,5966.4,1 through 10,percent of total billed charges,,,33.6,,3796.8,3796.8,3796.8,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,821.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1717.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,871.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,2373,2373,2373,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,433.54,433.54,442.82,16,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,821.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,871.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1175,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,838.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1717.69,,facility
PLMT URETERAL STENT PRQ,50694,CPT,361,RC,,,,outpatient,,,4151.98,415.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1027,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1519,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,3373.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3373.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3474.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3373.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,7050.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3576.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3373.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3576.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10137,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,3441.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,10137,,facility
L HRT CATH CHD NM/ABN NT CNJ,93595,CPT,480,RC,,,,outpatient,,,3880.91,388.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2004,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,2759,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,3102.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3102.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3195.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,4829.33,4829.33,4829.33,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3102.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,6484.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3288.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3102.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3288.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1463,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,3164.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,6484.66,,facility
ASSAY ACID PHOSPHATASE,84060,CPT,301,RC,,,,outpatient,,,9.55,0.96,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,7.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,15.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,7.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.96,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,7.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,7.64,448,,facility
RBC ANTIBODY ELUTION,86860,CPT,302,RC,,,,outpatient,,,203.43,20.34,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,167.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,289.34,289.34,312.91,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,340.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,172.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,172.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,226.07,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,166.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,163.06,448,,facility
EXC TR-EXT B9+MARG 1.1-2 CM,11402,CPT,761,RC,,,,outpatient,,,837.95,83.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,617.33,617.33,637.68,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,677.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,677.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,698.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,677.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1416.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,718.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,626.56,313.28,626.56,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,677.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,718.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,691.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1416.43,,facility
IGK REARRANGEABN CLONAL POP,81264,CPT,310,RC,,,,outpatient,,,215.91,21.59,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,172.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,172.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,177.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,365.57,365.57,365.57,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,172.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,361.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,183.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,172.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,183.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,322.61,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,176.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,172.73,448,,facility
HC INTERMEDIATE/STEPDOWN ICU ROOM DAILY,2.06E+12,CDM,206,RC,,,,inpatient,,,1180,118,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Stoploss First Dollar + Reimbursement Rate 64.00 + Basic Per Diem + Fixed Rate 2534.00 + Fixed Amount 106065.00,,,,0,other,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,Stoploss First Dollar + Reimbursement Rate 64.00 + Basic Per Diem + Fixed Rate 6210.00 + Fixed Amount 106065.00,,,,0,other,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Short Stay Lesser of + Days Threshold 1.00 + Stoploss First Dollar + Reimbursement Rate 57.00 + Basic Per Diem + Fixed Rate 5000.00 + Fixed Amount 157464.00,,,,0,other,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,Short Stay Lesser of + Days Threshold 1.00 + Stoploss First Dollar + Reimbursement Rate 72.00 + Basic Per Diem + Fixed Rate 10000.00 + Fixed Amount 56687.00,,,,0,other,NTE Percentage + Reimbursement Rate 85.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,Stoploss First Dollar + Reimbursement Rate 52.80 + Basic Per Diem + Fixed Rate 1174.00 + Fixed Amount 56100.00,,,,0,other,Stoploss First Dollar + Reimbursement Rate 52.80 + Basic Per Diem + Fixed Rate 1174.00 + Fixed Amount 56100.00 + No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,47.3,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5465,,,,,,,per diem,,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,5465,5465,,facility
REMOVE FOREIGN BODY FROM EYE,65210,CPT,361,RC,,,,outpatient,,,474.54,47.45,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,427.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,427.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,440.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,427.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,893.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,453.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,427.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,453.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2440,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,436.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,427.54,2440,,facility
HERPES SIMPLEX TYPE 1 TEST,86695,CPT,302,RC,,,,outpatient,,,16.49,1.65,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.73,11.73,11.73,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,20.59,20.59,42.71,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,13.1,13.1,13.1,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.73,11.73,11.73,15,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.49,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.19,448,,facility
ASSAY OF VASOPRESSIN,84588,CPT,301,RC,,,,outpatient,,,42.43,4.24,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,33.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,33.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,34.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,33.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,70.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,46.5,46.5,46.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,30.19,30.19,30.19,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,33.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,73.33,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,34.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,33.94,448,,facility
CESSJ THERAPY CATH REMOVAL,37214,CPT,361,RC,,,,outpatient,,,3796.26,379.63,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1027,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1519,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,3021.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3021.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3112.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3021.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,6315.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3203.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3021.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3203.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2712,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,3082.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,6315.75,,facility
MOPATH PROCEDURE LEVEL 2,81401,CPT,310,RC,,,,outpatient,,,171.25,17.13,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,121.86,121.86,121.86,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,137,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,137,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,141.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,137,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,286.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,145.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,137,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,145.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,239.75,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,139.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,137,448,,facility
INFLUENZA VIRUS ANTIBODY,86710,CPT,302,RC,,,,outpatient,,,16.94,1.69,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,28.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.28,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.55,448,,facility
DRAINAGE OF MOUTH LESION,41017,CPT,450,RC,,,,outpatient,,,3834.53,383.45,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3173.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3173.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3268.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3173.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,6631.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3363.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3173.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3363.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3236.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,6631.76,,facility
AR GENE CHARAC ALLELES,81204,CPT,310,RC,,,,outpatient,,,171.25,17.13,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,137,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,137,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,141.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,137,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,286.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,145.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,137,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,145.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,239.75,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,139.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,137,448,,facility
ASSAY OF URINE SULFATE,84392,CPT,301,RC,,,,outpatient,,,6.86,0.69,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,11.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.26,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.49,448,,facility
G6PC GENE,81250,CPT,310,RC,,,,outpatient,,,73.11,7.31,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,58.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,58.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,60.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,58.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,122.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,58.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,102.36,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,59.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,58.49,448,,facility
MSH6 GENE FULL SEQ,81298,CPT,310,RC,,,,outpatient,,,802.31,80.23,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,641.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,641.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,661.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,641.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1341.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,680.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,641.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,680.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1123.24,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,654.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1341.47,,facility
ESOPHAGOSCOPY FLEX BIOPSY,43202,CPT,750,RC,,,,outpatient,,,2266.24,226.62,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,1836.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1836.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1891.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1836.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3838.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1946.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1836.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1946.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3821,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1873.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3838.31,,facility
"INJ., TRAZIMERA, 10 MG",Q5116,HCPCS,636,RC,,,,outpatient,,,15.81,1.58,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,13.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,40.79,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.03,448,,facility
EP EVL 1/2CHMB TRNSVNS CVDFB,93642,CPT,480,RC,,,,outpatient,,,1417.44,141.74,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2004,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,2759,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,1165.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1165.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1200.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1165.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,2435.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1235.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1165.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1235.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1463,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1188.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,2759,,facility
NEUROMUSCULAR JUNCTION TEST,95937,CPT,922,RC,,,,outpatient,,,186.04,18.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,123.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,123.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,126.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,123.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,257.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,130.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,123.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,130.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,478,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,125.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,123.14,478,,facility
BLOOD TYPING SEROLOGIC ABO,86900,CPT,302,RC,,,,outpatient,,,152.14,15.21,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,113.1,113.1,127.33,523,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,207.68,21.24,207.68,13,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,131.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,118.27,18.88,200.99,116,percent of total billed charges,,,33.6,,118.27,18.88,118.27,44,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,118.27,12.1,134.11,78,percent of total billed charges,,,34.6,,130.24,127.78,134.11,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,266.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,134.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,176,17.88,176,13,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,73.92,7.56,73.92,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,2.66,2.66,2.66,1 through 10,percent of total billed charges,,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,2.66,2.66,2.66,824,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,134.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.46,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,129.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,6.46,448,,facility
R HRT CATH CHD NML NT CNJ,93593,CPT,480,RC,,,,outpatient,,,3880.91,388.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2004,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,2759,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,3102.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3102.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3195.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3102.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,6484.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3288.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3102.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3288.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1463,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,3164.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,6484.66,,facility
HEMOGLOBIN UNSTABLE SCREEN,83068,CPT,301,RC,,,,outpatient,,,11.84,1.18,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,9.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,19.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,9.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.29,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,9.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,9.47,448,,facility
ASSAY OF NICKEL,83885,CPT,301,RC,,,,outpatient,,,30.64,3.06,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,24.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,51.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,25.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,24.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,25.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,52.96,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,24.51,448,,facility
BREATHING CAPACITY TEST,94010,CPT,460,RC,,,,outpatient,,,186.04,18.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,137.28,137.28,206.65,40,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,398.72,382.72,398.72,13,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,206.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,206.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,212.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,209.33,209.33,328.94,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,202.72,202.72,209.33,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,206.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,431.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,219.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.63,15.63,16.08,346,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,206.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,219.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,611,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,210.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,206.65,611,,facility
AUTOMATED PLATELET COUNT,85049,CPT,305,RC,,,,outpatient,,,5.6,0.56,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,9.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.98,3.98,3.98,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.68,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,4.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,4.48,448,,facility
R&L HRT CATH W/VENTRICLGRPHY,93453,CPT,480,RC,,,,outpatient,,,3880.91,388.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2004,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,2759,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,3102.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3102.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3195.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3102.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,6484.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3288.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3102.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3288.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1463,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,3164.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,1463,6484.66,,facility
TISSUE CULTURE LYMPHOCYTE,88230,CPT,311,RC,,,,outpatient,,,145.61,14.56,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,103.62,103.62,103.62,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,588.16,588.16,588.16,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,116.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,116.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,119.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,485.23,47.52,485.23,1 through 10,percent of total billed charges,,,33.6,,308.78,308.78,485.23,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,308.78,265.78,308.78,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,116.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,243.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,123.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,103.62,103.62,103.62,12,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,116.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,123.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,251.69,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,118.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,116.49,448,,facility
MSH6 GENE DUP/DELETE VARIANT,81300,CPT,310,RC,,,,outpatient,,,297.5,29.75,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,238,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,238,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,245.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,238,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,497.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,252.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,238,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,252.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,416.5,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,242.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,238,497.42,,facility
CULTURE AEROBIC IDENTIFY,87077,CPT,306,RC,,,,outpatient,,,10.1,1.01,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,7.19,7.19,7.19,67,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,101.48,25.96,101.48,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,90.82,57.79,154.46,34,percent of total billed charges,,,33.6,,57.79,53.5,90.82,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,57.79,14.92,58.31,28,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,16.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,86,86,172,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,36.12,36.12,36.12,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,7.19,7.19,7.19,240,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.45,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,8.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,8.08,448,,facility
REMOVAL FOREIGN BODY MOUTH,40805,CPT,450,RC,,,,outpatient,,,655.29,65.53,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,516.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,516.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,531.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,516.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1078.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,547.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,516.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,547.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,526.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1311,,facility
CLTX CARPL FX W/MNPJ EA B1,25635,CPT,761,RC,,,,outpatient,,,1914.16,191.42,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1585.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3216.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1631.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1631.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,1569.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3216.38,,facility
EMERGENCY DEPT VISIT HI MDM,99285,CPT,450,RC,,,,outpatient,,,764.99,76.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,537.93,503.6,2323.13,245,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3080,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,4139,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1200,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1500,,,,,,,case rate,NTE Percentage + Reimbursement Rate 85.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,569.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,569.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,587.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,4074.08,2397.36,5611.22,1 through 10,percent of total billed charges,,,33.6,,2397.36,2397.36,3879.95,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,2397.36,2397.36,2397.36,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,569.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1191.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,604.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,3567.5,3567.5,3567.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,545.97,245.82,545.97,180,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,569.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,604.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,36.2,,2582.88,1418.03,4195.71,40,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,581.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,4139,,facility
HEMOGLOBIN PLASMA,83051,CPT,301,RC,,,,outpatient,,,9.14,0.91,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,7.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,15.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,7.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,7.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,7.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.8,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,7.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,7.31,448,,facility
EXPLORATION OF FOOT JOINT,28022,CPT,450,RC,,,,outpatient,,,3855.04,385.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3131.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3131.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3225.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3131.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,6544.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3319.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3131.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3319.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3194.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,6544.81,,facility
HEMOGLOBIN ELECTROPHORESIS,83020,CPT,301,RC,,,,outpatient,,,16.09,1.61,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.45,11.45,11.45,22,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,12.1,12.1,12.29,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,26.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,18,18,18,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,29.19,29.19,29.19,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.45,11.45,11.45,47,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.81,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.87,448,,facility
X-RAY EXAM OF FACIAL BONES,70150,CPT,320,RC,,,,outpatient,,,130.94,13.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,448,,facility
CLTX RDCRPL/NTRCRPL DISLC 1+,25660,CPT,450,RC,,,,outpatient,,,280.86,28.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,243.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,493.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,240.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,236.08,1173,,facility
BASIC METABLC PNL IONIZED CA,80047,CPT,301,RC,,,,outpatient,,,17.16,1.72,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.21,12.21,12.21,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,49.17,49.17,49.17,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,147.89,87.02,147.89,104,percent of total billed charges,,,33.6,,87.02,87.02,147.89,17,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,87.02,87.02,87.8,37,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,28.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,129.5,129.5,129.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,259,259,259,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.21,12.21,12.21,543,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.03,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.73,448,,facility
HARVEST AUTO STEM CELLS,38206,CPT,362,RC,,,,outpatient,,,1827.36,182.74,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,1438.32,1438.32,1438.32,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,1490.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1490.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1535.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,2084.88,2084.88,2084.88,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1490.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3115.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1579.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,1459.8,1459.8,1459.8,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1490.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1579.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1520.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3115.25,,facility
BIOPSY VAGINAL MUCOSA SIMPLE,57100,CPT,761,RC,,,,outpatient,,,957.45,95.75,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,764,764,764,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,881.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,881.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,907.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,881.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1842.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,934.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,775.41,775.41,775.41,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,881.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,934.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,899.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1842.34,,facility
STRAPPING OF HAND OR FINGER,29280,CPT,450,RC,,,,outpatient,,,72.85,7.29,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,56.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,56.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,58.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,56.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,118,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,59.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,56.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,59.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,57.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,56.46,448,,facility
DRUG ASSAY INFLIXIMAB,80230,CPT,301,RC,,,,outpatient,,,48.21,4.82,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,39.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,38.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,80.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,40.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,38.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,40.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,67.5,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,39.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,38.57,448,,facility
HEPATITIS C REVRS TRNSCRPJ,87522,CPT,306,RC,,,,outpatient,,,53.55,5.36,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,38.11,38.11,38.11,12,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,44.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,101.14,101.14,101.14,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,101.14,101.14,101.14,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,89.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,45.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,38.11,38.11,38.11,29,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,45.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,92.54,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,43.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,42.84,448,,facility
DRUG ASSAY LEFLUNOMIDE,80193,CPT,301,RC,,,,outpatient,,,48.21,4.82,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,39.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,38.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,80.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,40.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,38.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,40.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,67.5,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,39.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,38.57,448,,facility
EXTREMITY STUDY,93971,CPT,921,RC,,,,outpatient,,,130.94,13.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1227,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,1227,,facility
CONVERT NEPHROSTOMY CATHETER,50434,CPT,361,RC,,,,outpatient,,,2425.83,242.58,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,2000.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2000.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2060.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2000.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,4181.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2120.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2000.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2120.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2712,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,2040.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,4181.3,,facility
CLOSED TX ORBIT W/O MANIPULJ,21400,CPT,450,RC,,,,outpatient,,,655.29,65.53,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,516.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,516.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,531.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,516.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1078.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,547.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,516.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,547.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,526.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1311,,facility
X-LINKED INTELLECTUAL DBLT,81470,CPT,310,RC,,,,outpatient,,,1142.5,114.25,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,914,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,914,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,941.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,914,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1910.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,968.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,914,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,968.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1599.5,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,932.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1910.26,,facility
TB AG RESPONSE T-CELL SUSP,86481,CPT,302,RC,,,,outpatient,,,125,12.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,175,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100,448,,facility
MR ANGIOGRAPHY NECK W/O DYE,70547,CPT,610,RC,,,,outpatient,,,291.84,29.18,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,474.04,474.04,474.04,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,802,802,802,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1025,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1350,,,,,,,case rate,NTE Percentage + Reimbursement Rate 85.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,235.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,477.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,242.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,242.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2407,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,232.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,228.36,2407,,facility
DEEP MUSCLE BIOPSY,20205,CPT,761,RC,,,,outpatient,,,3384.19,338.42,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1027,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1519,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2779.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2779.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2863.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2779.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,5810.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2946.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2779.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2946.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,2835.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,5810.16,,facility
ASSAY OF TOTAL ESTRADIOL,82670,CPT,301,RC,,,,outpatient,,,34.93,3.49,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,24.85,24.85,24.85,51,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,47.79,39.12,263.73,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,42.77,42.77,42.77,15,percent of total billed charges,,,33.6,,42.77,27.46,236.02,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,27.46,27.22,150.19,27,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,27.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,58.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,29.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,40.5,40.5,40.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,17.01,17.01,17.01,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,24.85,24.85,24.85,85,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,27.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,29.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,60.36,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,28.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,27.94,448,,facility
HERED NEUROEND TUM-RLT DO 5+,81437,CPT,310,RC,,,,outpatient,,,548.66,54.87,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1303.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1303.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1343.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1303.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,2725.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1382.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1303.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1382.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,948.31,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1330.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,2725.26,,facility
CLOTTING FUNCT ACTIVITY,85397,CPT,305,RC,,,,outpatient,,,38.58,3.86,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,27.45,27.45,27.45,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,31.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,30.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,64.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,32.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,27.45,27.45,27.45,13,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,30.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,32.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,54.01,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,31.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,30.86,448,,facility
THER/PROPH/DIAG INJ SC/IM,96372,CPT,260,RC,,,,outpatient,,,83.9,8.39,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,62.45,58.46,64.84,221,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,99.2,99.2,99.2,64,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,91.45,91.45,91.45,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,68.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,68.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,70.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,81.84,52.08,81.84,42,percent of total billed charges,,,33.6,,52.08,52.08,52.08,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,52.08,40.34,104.16,15,percent of total billed charges,,,34.6,,281.32,281.32,281.32,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,68.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,144.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,73.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,63.38,63.38,126.76,383,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,68.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,73.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,427,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,70.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,68.91,448,,facility
STRAPPING OF TOES,29550,CPT,450,RC,,,,outpatient,,,72.85,7.29,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,56.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,56.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,58.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,56.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,118,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,59.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,56.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,59.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,57.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,56.46,448,,facility
NDL INSJ W/O NJX 3+ MUSC,20561,CPT,420,RC,,,,outpatient,,,35.46,3.55,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,80,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,27.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,57.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,29.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,27.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,29.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,422,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,28.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,27.68,1173,,facility
CARS/BD TST INFT-12MO 60 MIN,94780,CPT,460,RC,,,,outpatient,,,47.76,4.78,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,74.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,611,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,36.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.74,611,,facility
COLLECT BLOOD FROM PICC,36592,CPT,761,RC,,,,outpatient,,,152.14,15.21,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,113.1,105.88,113.1,37,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,114.79,114.79,114.79,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,131.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,471.08,471.08,686.51,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,266.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,134.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,412.5,412.5,412.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,114.79,114.79,114.79,74,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,134.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,291.31,58.96,466.95,38,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,129.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,127.33,448,,facility
BLOOD TYPING SEROLOGIC RH(D),86901,CPT,302,RC,,,,outpatient,,,47.76,4.78,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,2.66,2.66,62.15,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,155.76,19.47,155.76,14,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,88.7,17.42,150.74,116,percent of total billed charges,,,33.6,,88.7,17.42,88.7,44,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,88.7,11.09,100.58,78,percent of total billed charges,,,34.6,,97.68,95.83,100.58,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,74.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,132,16.5,132,13,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,55.44,6.93,55.44,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,2.66,2.66,2.66,1 through 10,percent of total billed charges,,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,2.66,2.66,2.66,829,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.46,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,36.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,6.46,448,,facility
TCAT INS 2CHMBR LDLS PM RV,0797T,CPT,480,RC,,,,outpatient,,,23206.69,2320.67,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1268,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1793,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 6500.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 10000.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,18434.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18434.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18987.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18434.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38528.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19540.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18434.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19540.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1463,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18803.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,38528.19,,facility
RPR F/E/E/N/L/M 7.6-12.5 CM,12015,CPT,761,RC,,,,outpatient,,,238.44,23.84,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,197.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,401.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,203.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,203.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,195.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,192.01,1173,,facility
BONE LENGTH STUDIES,77073,CPT,320,RC,,,,outpatient,,,130.94,13.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,448,,facility
CLTX MED ANKLE FX W/MNPJ,27762,CPT,761,RC,,,,outpatient,,,1914.16,191.42,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1585.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3216.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1631.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1631.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,1569.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3216.38,,facility
ECHO EXAM OF HEAD,76506,CPT,402,RC,,,,outpatient,,,130.94,13.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,1226.24,1226.24,1226.24,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,740.21,740.21,740.21,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,1101.5,1101.5,1101.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,64.2,64.2,64.2,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,465,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,465,,facility
TX SUPFC WND DEHSN SMPL CLSR,12020,CPT,761,RC,,,,outpatient,,,748,74.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,707.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,707.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,728.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,707.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1478.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,749.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,707.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,749.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,721.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1478.34,,facility
SCLEROTX FLUID COLLECTION,49185,CPT,320,RC,,,,outpatient,,,1930.94,193.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,1421.6,1421.6,1421.6,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1628.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3303.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1675.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1675.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1612.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,443,3303.62,,facility
M. GENITALIUM AMP PROBE,87563,CPT,306,RC,,,,outpatient,,,43.86,4.39,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,61.41,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
OVA AND PARASITES SMEARS,87177,CPT,306,RC,,,,outpatient,,,11.13,1.11,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,7.92,7.92,7.92,19,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,60.8,60.8,205.44,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,50.16,31.92,50.16,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,31.92,31.92,31.92,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,18.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,9.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,7.92,7.92,7.92,21,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,9.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.23,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,9.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,8.9,448,,facility
HLA CLASS II HIGH DEFIN QUAL,86833,CPT,302,RC,,,,outpatient,,,407.25,40.73,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,289.79,289.79,289.79,24,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,325.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,325.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,335.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,603.5,603.5,603.5,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,440.44,440.44,440.44,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,325.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,680.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,345.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,289.79,289.79,577.76,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,325.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,345.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,570.15,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,332.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,325.8,680.92,,facility
HEMATOCRIT,85014,CPT,305,RC,,,,outpatient,,,2.96,0.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,2.11,2.11,2.11,26,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,12.16,12.16,78.72,14,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,3.32,3.32,11.21,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,68.24,41.33,70.23,31,percent of total billed charges,,,33.6,,10.03,10.03,41.33,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,41.33,6.38,41.7,26,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,4.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,61.5,9.5,61.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,2.11,2.11,2.11,164,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.13,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,2.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,2.37,448,,facility
TREATMENT OF ANKLE FRACTURE,27788,CPT,761,RC,,,,outpatient,,,280.86,28.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,243.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,493.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,240.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,236.08,1173,,facility
RICKETTSIA ANTIBODY,86757,CPT,302,RC,,,,outpatient,,,24.19,2.42,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,17.21,17.21,17.21,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,40.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,20.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,17.21,17.21,17.21,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,20.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,41.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,19.35,448,,facility
HBA1/HBA2 GENE DUP/DEL VRNTS,81269,CPT,310,RC,,,,outpatient,,,253,25.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,180.03,180.03,180.03,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,202.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,202.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,208.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,292.99,292.99,292.99,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,202.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,423.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,214.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,202.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,214.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,354.2,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,206.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,202.4,448,,facility
CCP ANTIBODY,86200,CPT,302,RC,,,,outpatient,,,16.19,1.62,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.52,11.52,11.52,14,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,70.8,70.8,70.8,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,63.36,25.87,63.36,1 through 10,percent of total billed charges,,,33.6,,40.32,40.32,63.36,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,33.26,16.46,40.68,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.52,11.52,11.52,56,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.97,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.95,448,,facility
HEPATITIS B SURFACE AG IA,87340,CPT,306,RC,,,,outpatient,,,12.91,1.29,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9.19,9.19,9.19,137,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,51.92,51.92,51.92,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,46.46,29.57,140.35,57,percent of total billed charges,,,33.6,,46.46,29.57,46.46,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,29.57,29.57,29.92,75,percent of total billed charges,,,34.6,,34.67,12.1,42.83,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,21.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,44,44,44.13,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,9.19,9.19,9.19,1 through 10,percent of total billed charges,,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9.19,9.19,9.19,421,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.31,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,10.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,10.33,448,,facility
FMRI BRAIN BY TECH,70554,CPT,611,RC,,,,outpatient,,,291.84,29.18,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1025,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1350,,,,,,,case rate,NTE Percentage + Reimbursement Rate 85.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,235.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,477.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,242.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,242.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2407,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,232.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,228.36,2407,,facility
X-RAY EXAM THORAC SPINE4/>VW,72074,CPT,320,RC,,,,outpatient,,,130.94,13.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,448,,facility
ASSAY BLOOD CARBON DIOXIDE,82374,CPT,301,RC,,,,outpatient,,,6.1,0.61,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.34,4.34,4.34,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,9.76,9.76,9.76,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,48.54,28.56,48.54,1 through 10,percent of total billed charges,,,33.6,,28.56,28.56,28.56,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,28.57,28.56,57.12,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,10.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.34,4.34,4.34,35,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.55,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,4.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,4.88,448,,facility
DEGARELIX INJECTION,J9155,HCPCS,636,RC,,,,outpatient,,,5.34,0.53,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,4.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,9.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.2,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,4.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,4.48,448,,facility
TLH W/T/O UTERUS OVER 250 G,58573,CPT,761,RC,,,,outpatient,,,12259.7,1225.97,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1674,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,2484,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10173.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10173.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10478.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10173.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,21262.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10783.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10173.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10783.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,10376.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,21262.32,,facility
"BRACHYTX, STRANDED, I-125",C2638,HCPCS,278,RC,,,,outpatient,,,52.23,5.22,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,66,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,61,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,73.34,,facility
X-RAY EXAM SI JOINTS,72200,CPT,320,RC,,,,outpatient,,,130.94,13.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,448,,facility
ASSAY OF URINE VMA,84585,CPT,301,RC,,,,outpatient,,,19.38,1.94,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.79,13.79,13.79,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,32.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.79,13.79,13.79,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,33.48,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,15.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,15.5,448,,facility
SARSCOV2&INF A&B&RSV AMP PRB,87637,CPT,306,RC,,,,outpatient,,,124,12.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,126.87,126.87,126.87,915,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,142.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,142.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,146.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,185,108.86,185.01,29,percent of total billed charges,,,33.6,,108.86,108.86,185.01,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,108.86,108.86,108.86,17,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,142.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,298.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,151.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,68.04,68.04,68.04,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,126.87,126.87,126.87,793,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,142.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,151.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,249.55,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,145.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,142.63,448,,facility
ASSAY OF FERRITIN,82728,CPT,301,RC,,,,outpatient,,,17.04,1.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.12,12.12,12.12,348,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,56.64,56.64,185.26,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,50.69,32.26,165.79,96,percent of total billed charges,,,33.6,,32.26,32.26,165.79,18,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,32.26,32.26,105.5,115,percent of total billed charges,,,34.6,,116.18,116.18,116.18,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,28.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,48,48,48,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,65.94,20.16,65.94,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.12,12.12,12.12,882,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.45,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.63,448,,facility
CLTX SPRCNDYLR HUMERAL FX WO,24530,CPT,761,RC,,,,outpatient,,,280.86,28.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,243.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,493.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,240.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,236.08,1173,,facility
ASSAY OF URINE PHOSPHORUS,84105,CPT,301,RC,,,,outpatient,,,7.23,0.72,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.14,5.14,5.14,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,12.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.18,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.78,448,,facility
APC GENE FULL SEQUENCE,81201,CPT,310,RC,,,,outpatient,,,975,97.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,780,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,780,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,803.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,780,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1630.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,826.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,780,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,826.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1365,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,795.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1630.2,,facility
VASCULAR STUDY,93978,CPT,921,RC,,,,outpatient,,,291.84,29.18,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,235.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,477.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,242.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,242.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1227,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,232.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,228.36,1227,,facility
IRON BINDING TEST,83550,CPT,301,RC,,,,outpatient,,,10.93,1.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,7.77,7.77,7.77,268,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,231.28,231.28,231.28,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,206.98,131.71,206.98,54,percent of total billed charges,,,33.6,,131.71,131.71,206.98,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,131.71,131.71,132.89,63,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,18.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,9.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,196,196,196,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,7.77,7.77,7.77,697,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,9.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.88,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,8.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,8.74,448,,facility
SMEAR FLUORESCENT/ACID STAI,87206,CPT,306,RC,,,,outpatient,,,6.74,0.67,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.79,4.79,4.79,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,11.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.79,4.79,4.79,21,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.64,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.39,448,,facility
REMOVAL FOREIGN BODY MOUTH,40804,CPT,450,RC,,,,outpatient,,,1079.61,107.96,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,868.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,868.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,894.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,868.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1814.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,920.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,868.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,920.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,885.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1814.2,,facility
FXN GENE KNOWN FAMIL VARIANT,81289,CPT,310,RC,,,,outpatient,,,231.5,23.15,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,185.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,185.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,190.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,185.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,387.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,196.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,185.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,196.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,324.1,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,188.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,185.2,448,,facility
DRUG SCRN QUANT OXCARBAZEPIN,80183,CPT,301,RC,,,,outpatient,,,16.56,1.66,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.79,11.79,11.79,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.79,11.79,11.79,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.63,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.25,448,,facility
RADIATION PHYSICS CONSULT,77370,CPT,333,RC,,,,outpatient,,,161.6,16.16,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,128.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,128.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,132.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,128.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,268.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,136.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,128.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,136.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,48815,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,131.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,128.64,48815,,facility
HRDTRY CARDMYPY GENE PANEL,81439,CPT,310,RC,,,,outpatient,,,731.13,73.11,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,584.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,584.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,602.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,584.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1222.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,619.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,584.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,619.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1263.68,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,596.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1263.68,,facility
US EXAM INFANT HIPS STATIC,76886,CPT,402,RC,,,,outpatient,,,108.23,10.82,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,85.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,174.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,465,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,84.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,83.29,465,,facility
GLUCOSE BLOOD TEST,82962,CPT,301,RC,,,,outpatient,,,4.1,0.41,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,2.92,2.92,2.92,20,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,8.96,2.92,8.96,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,7.99,4.7,15.99,75,percent of total billed charges,,,33.6,,4.7,4.7,8.89,13,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,4.7,3.73,9.41,36,percent of total billed charges,,,34.6,,5.08,5.08,5.33,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,6.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,7,5.5,28,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,2.94,2.94,5.88,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,2.92,2.92,2.92,677,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.74,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,3.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,3.28,448,,facility
SUGARS MULTIPLE QUAL,84377,CPT,301,RC,,,,outpatient,,,6.88,0.69,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,11.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.88,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.5,448,,facility
CT MAXILLOFACIAL W/O DYE,70486,CPT,351,RC,,,,outpatient,,,130.94,13.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,197.02,93.3,381.77,149,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,403,,,,,,,case rate,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,371,,,,,,,case rate,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,378,378,411,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,875,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1050,,,,,,,case rate,NTE Percentage + Reimbursement Rate 85.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,2721.31,1731.74,2942.93,20,percent of total billed charges,,,33.6,,1731.74,1731.74,1731.74,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,1731.74,1731.74,1747.21,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,72.57,72.57,76.07,81,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1522,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,1522,,facility
CLEAN OUT MASTOID CAVITY,69222,CPT,761,RC,,,,outpatient,,,655.29,65.53,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,516.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,516.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,531.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,516.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1078.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,547.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,516.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,547.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,526.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1311,,facility
EGD ENDO MUCOSAL RESECTION,43254,CPT,750,RC,,,,outpatient,,,2266.24,226.62,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,1664.42,1664.42,1664.42,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,1027,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1519,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,1836.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1836.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1891.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,4171.19,4171.19,4171.19,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1836.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3838.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1946.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1836.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1946.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3821,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1873.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3838.31,,facility
NEG PRS WND THER DME>50 SQCM,97606,CPT,420,RC,,,,outpatient,,,474.9,47.49,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,80,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,390.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,390.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,402.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,390.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,817.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,414.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,390.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,414.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,422,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,398.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,80,817.13,,facility
BONE AGE STUDIES,77072,CPT,320,RC,,,,outpatient,,,130.94,13.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,423.04,368,423.04,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,389.99,389.99,389.99,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,368,368,368,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,349.01,194.93,349.01,1 through 10,percent of total billed charges,,,33.6,,222.1,222.1,222.1,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,222.1,222.1,222.1,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,330.5,330.5,330.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,448,,facility
SMEAR GRAM STAIN,87205,CPT,306,RC,,,,outpatient,,,5.34,0.53,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.8,3.8,3.8,30,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,180.48,3.16,180.48,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,166.38,166.38,166.38,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,94.75,94.75,148.9,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,94.75,94.75,95.6,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,8.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.8,3.8,3.8,139,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.22,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,4.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,4.27,448,,facility
DX LMBR SPI PNXR W/FLUOR/CT,62328,CPT,361,RC,,,,outpatient,,,823.63,82.36,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,658.74,607.62,5596.02,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,675.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,675.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,695.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,947.52,947.52,1266.18,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,675.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1411.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,716.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,675.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,716.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2712,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,689.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,2712,,facility
TIS TRNFR E/N/E/L10.1-30SQCM,14061,CPT,761,RC,,,,outpatient,,,2171.91,217.19,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,1604.98,1604.98,1604.98,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,1027,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1519,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1974.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1974.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2033.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1974.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,4127.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2093.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1974.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2093.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,2014.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,4127.08,,facility
DRESSING CHANGE NOT FOR BURN,15852,CPT,761,RC,,,,outpatient,,,748,74.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,707.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,707.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,728.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,707.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1478.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,749.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,577.76,577.76,577.76,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,707.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,749.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,721.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1478.34,,facility
EMA EACH IG CLASS,86231,CPT,302,RC,,,,outpatient,,,15.11,1.51,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9,9,9,55,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,5.31,5.31,24.19,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,4.75,3.05,21.65,17,percent of total billed charges,,,33.6,,3.02,3.02,3.02,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,3.02,3.02,3.05,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,4.5,4.5,4.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9,9,10.75,200,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.16,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.09,448,,facility
ASSAY OF BLOOD LIPOPROTEIN,83721,CPT,301,RC,,,,outpatient,,,13.13,1.31,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9.34,9.34,9.34,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,29.5,29.5,29.5,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,21.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9.34,9.34,9.34,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.62,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,10.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,10.5,448,,facility
ASSAY OF CREATINE,82540,CPT,301,RC,,,,outpatient,,,5.8,0.58,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,9.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.01,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,4.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,4.64,448,,facility
TISSUE HOMOGENIZATION CULTR,87176,CPT,306,RC,,,,outpatient,,,7.35,0.74,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,12.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.71,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.88,448,,facility
EXT ECG>7D<15D SCAN A/R,93247,CPT,730,RC,,,,outpatient,,,152.14,15.21,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,131.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,266.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,134.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,134.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,389,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,129.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,127.33,448,,facility
DRUG ASSAY RUFINAMIDE,80210,CPT,301,RC,,,,outpatient,,,33.89,3.39,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,27.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,56.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,28.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,27.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,28.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,47.44,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,27.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,27.11,448,,facility
ANTINUCLEAR ANTIBODIES,86038,CPT,302,RC,,,,outpatient,,,15.11,1.51,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.75,10.75,10.75,34,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,148.09,148.09,148.09,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,84.34,29.04,132.53,14,percent of total billed charges,,,33.6,,84.34,18.48,127.78,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,84.34,84.34,85.09,12,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,11.55,11.55,11.55,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.75,10.75,10.75,126,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.11,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.09,448,,facility
AR GENE FULL GENE SEQUENCE,81173,CPT,310,RC,,,,outpatient,,,376.69,37.67,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,301.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,301.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,310.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,301.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,629.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,319.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,301.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,319.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,527.36,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,307.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,301.35,629.82,,facility
ENZYME CELL ACTIVITY RA,82658,CPT,301,RC,,,,outpatient,,,55.04,5.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,44.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,44.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,45.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,44.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,92.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,46.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,44.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,46.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,77.05,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,44.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,44.03,448,,facility
BILIRUBIN TOTAL TRANSCUT,88720,CPT,300,RC,,,,outpatient,,,6.28,0.63,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,10.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.02,448,,facility
X-RAY EXAM OF PELVIS,72170,CPT,320,RC,,,,outpatient,,,130.94,13.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,540.8,498.55,540.8,24,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,498.55,498.55,498.55,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,446.16,283.92,482.5,51,percent of total billed charges,,,33.6,,283.92,283.92,446.16,14,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,283.92,283.92,286.46,28,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,422.5,422.5,422.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.9,15.9,16.36,99,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,448,,facility
COLD AGGLUTININ SCREEN,86156,CPT,302,RC,,,,outpatient,,,10.09,1.01,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,250.8,250.8,271.22,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,16.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.47,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,8.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,8.07,448,,facility
ASPIRATE PLEURA W/O IMAGING,32554,CPT,361,RC,,,,outpatient,,,748.19,74.82,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,600.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,600.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,618.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,600.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1254.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,636.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,600.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,636.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2712,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,612.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,2712,,facility
CONSTJ TRACHESOPHGL FSTL,31611,CPT,761,RC,,,,outpatient,,,3834.53,383.45,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1027,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1519,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3173.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3173.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3268.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3173.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,6631.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3363.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3173.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3363.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,3236.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,6631.76,,facility
HEP B SURFACE AG NEUTRLZJ IA,87341,CPT,306,RC,,,,outpatient,,,12.91,1.29,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,21.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.31,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,10.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,10.33,448,,facility
TISSUE CULTURE PLACENTA,88235,CPT,311,RC,,,,outpatient,,,187.88,18.79,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,133.69,133.69,133.69,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,150.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,150.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,154.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,150.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,314.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,159.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,133.69,133.69,1031.8,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,150.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,159.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,318.17,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,153.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,150.3,448,,facility
CLOSURE OF EYELID BY SUTURE,67875,CPT,361,RC,,,,outpatient,,,1205.8,120.58,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,954.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,954.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,982.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,954.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1994.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1011.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,954.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1011.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3821,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,973.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3821,,facility
X-RAY EXAM OF ANKLE,73610,CPT,320,RC,,,,outpatient,,,108.23,10.82,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,85.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,174.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,22.64,22.64,23.58,88,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,84.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,83.29,448,,facility
IMHCHEM/IMCYTCHM 1ST ANTB,88342,CPT,310,RC,,,,outpatient,,,203.43,20.34,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,150.35,150.35,163,21,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,412.16,68.86,412.16,25,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,379.96,379.96,379.96,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,167.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,289.16,216.38,432.77,28,percent of total billed charges,,,33.6,,216.38,43.79,340.03,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,216.38,216.38,218.32,28,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,340.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,172.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,322,322,644,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,63.66,60.24,63.66,181,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,172.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,377,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,166.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,163.06,448,,facility
NRPSYC TST EVAL PHYS/QHP 1ST,96132,CPT,918,RC,,,,outpatient,,,638.35,63.84,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,357.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,357.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,367.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,357.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,746.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,378.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,357.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,378.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1372,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,364.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,357.13,1372,,professional
X-RAY EXAM RIBS/CHEST4/> VWS,71111,CPT,320,RC,,,,outpatient,,,130.94,13.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,448,,facility
DRAIN/INJ JOINT/BURSA W/US,20604,CPT,361,RC,,,,outpatient,,,352.75,35.28,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,293.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,293.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,302.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,293.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,613.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,311.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,293.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,311.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2440,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,299.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,293.77,2440,,facility
MNPJ CHEST WALL 1ST,94667,CPT,410,RC,,,,inpatient,,,152.14,15.21,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Short Stay Lesser of + Days Threshold 1.00 + Stoploss First Dollar + Reimbursement Rate 57.00 + Basic Per Diem + Fixed Rate 5000.00 + Fixed Amount 157464.00,,,,0,other,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,Short Stay Lesser of + Days Threshold 1.00 + Stoploss First Dollar + Reimbursement Rate 72.00 + Basic Per Diem + Fixed Rate 10000.00 + Fixed Amount 56687.00,,,,0,other,NTE Percentage + Reimbursement Rate 85.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,47.3,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,20.78,20.78,20.78,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,facility
"BLOOD, L/R, CMV-NEG",P9051,HCPCS,390,RC,,,,outpatient,,,209.06,20.91,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,150.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,150.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,155.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,150.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,315.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,159.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,150.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,159.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,107,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,153.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,107,448,,facility
CYSTOSCOPY AND TREATMENT,52281,CPT,761,RC,,,,outpatient,,,2425.83,242.58,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2000.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2000.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2060.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2000.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,4181.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2120.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2000.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2120.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,2040.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,4181.3,,facility
ASSAY OF CADMIUM,82300,CPT,301,RC,,,,outpatient,,,29.55,2.96,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,23.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,23.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,23.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,49.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,25.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,21.03,21.03,21.03,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,23.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,25.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,50.02,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,24.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,23.64,448,,facility
SPECIAL STAINS GROUP 2,88313,CPT,310,RC,,,,outpatient,,,72.85,7.29,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,117.45,117.45,127.33,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,131.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,1158.42,1158.42,1448.02,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,216.72,216.72,650.16,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,266.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,134.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,322.5,322.5,322.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,56.91,56.91,59.4,38,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,134.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,55.65,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,129.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,55.65,448,,facility
AUTOLOGOUS BLOOD PROCESS,86890,CPT,390,RC,,,,outpatient,,,203.43,20.34,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,167.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,340.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,172.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,172.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,377,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,166.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,163.06,448,,facility
ASSAY OF THEOPHYLLINE,80198,CPT,301,RC,,,,outpatient,,,17.68,1.77,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,29.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.56,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.14,448,,facility
ASSAY OF LIPOPROTEIN,83718,CPT,301,RC,,,,outpatient,,,10.24,1.02,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,7.28,7.28,7.28,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,17.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.71,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,8.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,8.19,448,,facility
ASSAY OF CRYOGLOBULIN,82595,CPT,301,RC,,,,outpatient,,,8.09,0.81,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.75,5.75,5.75,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,38.54,38.54,38.54,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,13.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.75,5.75,5.75,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.97,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,6.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,6.47,448,,facility
CLTX ACROMCLAV DISLC W/MNPJ,23545,CPT,450,RC,,,,outpatient,,,280.86,28.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,243.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,493.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,240.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,236.08,1173,,facility
AORTIC DYSFUNCTION/DILATION,81410,CPT,310,RC,,,,outpatient,,,630,63,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,504,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,504,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,519.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,504,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1053.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,534.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,504,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,534.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,882,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,514.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1053.36,,facility
TREAT SESAMOID BONE FRACTURE,28530,CPT,450,RC,,,,outpatient,,,280.86,28.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,243.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,493.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,240.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,236.08,1173,,facility
BIOPSY OF MOUTH LESION,40808,CPT,761,RC,,,,outpatient,,,655.29,65.53,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,516.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,516.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,531.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,516.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1078.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,547.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,516.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,547.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,526.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1173,,facility
ACETYLCHOLN RCPTR BLCKG ANTB,86042,CPT,302,RC,,,,outpatient,,,23,2.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.37,16.37,16.37,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.2,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.4,448,,facility
CTA ABD&PLVS W/CONTRAST,74174,CPT,352,RC,,,,outpatient,,,458.03,45.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,313.35,307.99,333.9,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,411,411,411,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,875,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1050,,,,,,,case rate,NTE Percentage + Reimbursement Rate 85.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,333.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,333.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,343.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,1268.76,1268.76,1268.76,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,746.59,579.35,746.59,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,333.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,697.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,353.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,466.62,466.62,466.62,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,228.47,228.47,239.84,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,333.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,353.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1522,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,340.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,333.9,1522,,facility
SUGARS SINGLE QUANT,84378,CPT,301,RC,,,,outpatient,,,14.41,1.44,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,24.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.9,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,11.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.53,448,,facility
PRGRMG EVAL IMPLANTABLE DFB,93282,CPT,480,RC,,,,outpatient,,,44.91,4.49,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,179.84,179.84,179.84,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,35.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,74.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,30.74,30.74,32.47,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1463,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,36.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.71,1463,,facility
"INJ, TEBENTAFUSP-TEBN, 1 MCG",J9274,HCPCS,636,RC,,,,outpatient,,,268.2,26.82,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,228.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,228.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,234.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,228.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,476.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,241.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,228.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,241.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,461.73,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,232.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,228.01,476.54,,facility
RBC ANTIBODY IDENTIFICATION,86870,CPT,302,RC,,,,outpatient,,,428.1,42.81,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,315.62,315.62,343.05,52,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,343.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,343.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,353.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,289.34,289.34,578.69,17,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,198.92,198.92,596.77,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,343.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,716.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,363.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,23.42,23.42,46.84,19,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,343.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,363.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,377,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,349.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,343.05,716.97,,facility
ESOPH IMPED FUNCT TEST > 1HR,91038,CPT,750,RC,,,,outpatient,,,638.35,63.84,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,357.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,357.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,367.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,357.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,746.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,378.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,357.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,378.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2440,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,364.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,357.13,2440,,facility
BAMLAN AND ETESEV INFUSION,M0245,HCPCS,771,RC,,,,outpatient,,,563.13,56.31,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 103.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment.",,,,0,other,"Payer contract is 103.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment. + No services performed during 15-month lookback period",,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment. + No services performed during 15-month lookback period",,,"Payer contract is 209.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment.",,,,0,other,"Payer contract is 209.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment. + No services performed during 15-month lookback period",,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment. + No services performed during 15-month lookback period",,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,232,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,"Payer contract is 102.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment.",,,,0,other,"Payer contract is 102.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment. + No services performed during 15-month lookback period",232,448,,facility
TREATMENT OF TIBIA FRACTURE,27750,CPT,761,RC,,,,outpatient,,,280.86,28.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,243.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,493.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,240.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,236.08,1173,,facility
RPR LIP FTH>1HALF VER HT/CPX,40654,CPT,450,RC,,,,outpatient,,,1816.31,181.63,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1027,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1519,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1484.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1484.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1529.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1484.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3103.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1574.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1484.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1574.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1514.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3103.57,,facility
IMMUNOASSAY TUMOR OTHER,86316,CPT,302,RC,,,,outpatient,,,26.01,2.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,18.51,18.51,18.51,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,76.03,32.21,76.03,1 through 10,percent of total billed charges,,,33.6,,48.38,48.38,48.38,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,20.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,43.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,18.51,18.51,18.51,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,20.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,44.98,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,21.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,20.81,448,,facility
ECHO EXAM OF FETAL HEART,76825,CPT,402,RC,,,,outpatient,,,657.04,65.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,3160.32,3160.32,3160.32,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,522.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,522.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,538.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,2607.26,2607.26,5214.53,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,522.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1092.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,554.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,522.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,554.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,465,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,533.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1092.97,,facility
THER INJECTION CARP TUNNEL,20526,CPT,761,RC,,,,outpatient,,,352.75,35.28,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,293.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,293.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,302.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,293.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,613.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,311.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,293.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,311.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,299.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,293.77,1173,,facility
UNLISTED PX VASCULAR SURGERY,37799,CPT,761,RC,,,,outpatient,,,748.19,74.82,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,600.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,600.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,618.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,448.67,448.67,448.67,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,600.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1254.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,636.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,600.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,636.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,599.86,126.95,599.86,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,612.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1311,,facility
DELAY FLAP EYE/NOS/EAR/LIP,15630,CPT,761,RC,,,,outpatient,,,2171.91,217.19,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1027,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1519,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1974.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1974.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2033.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1974.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,4127.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2093.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1974.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2093.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,2014.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,4127.08,,facility
CHEMO IV INFUSION 1 HR,96413,CPT,335,RC,,,,outpatient,,,403.35,40.34,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,291.03,272.45,297.44,965,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,646.4,646.4,646.4,186,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,595.9,441.71,595.9,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,316.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,316.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,325.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,533.28,339.36,533.28,179,percent of total billed charges,,,33.6,,339.36,339.36,533.28,48,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,339.36,339.36,342.39,112,percent of total billed charges,,,34.6,,373.7,373.7,384.81,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,316.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,660.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,335.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,505,505,505,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,212.1,212.1,212.1,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,295.37,295.37,297.44,776,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,316.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,335.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1603,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,322.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,316.12,1603,,facility
ASSAY OF NOS VITAMIN,84591,CPT,301,RC,,,,outpatient,,,21.33,2.13,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,35.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.86,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.06,448,,facility
REMOVE NASAL FOREIGN BODY,30300,CPT,761,RC,,,,outpatient,,,152.14,15.21,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,131.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,266.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,134.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,134.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,129.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,127.33,448,,facility
LARYNGOSCOPY W/BIOPSY,31535,CPT,510,RC,,,,outpatient,,,4460.06,446.01,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3568.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3568.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3675.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3568.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,7457.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3782.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3568.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3782.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,3639.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,7457.62,,facility
GAMMAGARD LIQUID/ERC INJ,J1569,HCPCS,636,RC,,,,outpatient,,,56.34,5.63,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,49.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,49.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,50.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,49.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,103.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,52.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,49.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,52.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,99.89,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,50.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,49.3,448,,facility
AEP THRSHLD EST MLT FREQ I&R,92652,CPT,471,RC,,,,outpatient,,,373.83,37.38,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,273.22,273.22,273.22,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,206.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,206.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,212.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,206.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,431.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,219.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,92.49,92.49,98.21,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,206.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,219.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,425,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,210.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,206.65,448,,facility
ASSAY OF GLYCATED PROTEIN,82985,CPT,301,RC,,,,outpatient,,,20.95,2.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,14.91,14.91,14.91,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,29.57,29.57,29.57,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,35.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,14.91,14.91,14.91,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.57,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,16.76,448,,facility
I&D EPDIDYMS TSTIS&/SCROT SP,54700,CPT,761,RC,,,,outpatient,,,2425.83,242.58,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2000.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2000.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2060.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2000.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,4181.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2120.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2000.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2120.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,2040.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,4181.3,,facility
INTERROGATION VAD IN PERSON,93750,CPT,480,RC,,,,outpatient,,,115.29,11.53,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,90.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,90.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,93.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,90.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,190.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,96.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,90.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,96.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1463,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,92.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,90.99,1463,,facility
FATS/LIPIDS FECES QUANT,82710,CPT,301,RC,,,,outpatient,,,21,2.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,35.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.31,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,16.8,448,,facility
BLOOD TYPING RBC ANTIGENS,86905,CPT,390,RC,,,,outpatient,,,428.1,42.81,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,343.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,343.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,353.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,343.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,716.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,363.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,343.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,363.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.28,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,349.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,8.28,716.97,,facility
SARS-COV-2 COVID-19 AMP PRB,87635,CPT,306,RC,,,,outpatient,,,64.14,6.41,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,45.64,45.64,45.64,30,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,51.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,51.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,52.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,131.33,121.44,131.33,1 through 10,percent of total billed charges,,,33.6,,77.28,77.28,77.28,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,77.28,77.28,77.28,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,51.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,107.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,54.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,45.64,45.64,45.64,27,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,51.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,54.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,89.79,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,52.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,51.31,448,,facility
CLTX MNDBLR FX W/MNPJ,21451,CPT,761,RC,,,,outpatient,,,1816.31,181.63,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1268,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1793,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1484.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1484.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1529.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1484.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3103.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1574.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1484.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1574.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,1514.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3103.57,,facility
COLONOSCOPY W/LESION REMOVAL,45385,CPT,750,RC,,,,outpatient,,,1405.45,140.55,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,1034.53,517.26,1077.58,18,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,458,458,458,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1179.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,2187.98,2073.12,2770.33,11,percent of total billed charges,,,33.6,,2770.33,2073.12,8977.08,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,2073.12,2073.12,2073.12,17,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,2393.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1213.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,3085,3085,3085,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,1295.7,1295.7,1295.7,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,1049.99,1049.99,1077.58,11,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1213.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3821,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1168.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3821,,facility
MIDDLE CEREBRAL ARTERY ECHO,76821,CPT,402,RC,,,,outpatient,,,130.94,13.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,465,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,465,,facility
I&D F/ARM&/WRST DP ABSC/HMTM,25028,CPT,450,RC,,,,outpatient,,,3855.04,385.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3131.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3131.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3225.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3131.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,6544.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3319.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3131.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3319.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3194.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,6544.81,,facility
TREAT THIGH FRACTURE,27246,CPT,450,RC,,,,outpatient,,,280.86,28.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,243.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,493.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,240.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,236.08,1173,,facility
LARYNGOSCOPY FOR ASPIRATION,31515,CPT,761,RC,,,,outpatient,,,486.31,48.63,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,374.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,374.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,385.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,374.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,782.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,396.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,374.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,396.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,381.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,374.33,1173,,facility
TREATMENT OF THIGH FRACTURE,27502,CPT,761,RC,,,,outpatient,,,1914.16,191.42,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1585.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3216.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1631.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1631.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,1569.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3216.38,,facility
BASIC METABOLIC PNL TOTAL CA,80048,CPT,301,RC,,,,outpatient,,,10.58,1.06,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,7.53,7.53,7.53,173,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,25.96,11.84,443.68,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,28.16,28.16,28.16,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,254.93,23.23,429.39,147,percent of total billed charges,,,33.6,,252.67,14.78,429.39,26,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,14.92,14.78,252.67,149,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,17.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,22,22,376,21,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,9.24,9.24,157.92,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,7.53,7.53,7.53,1135,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.27,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,8.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,8.46,448,,facility
NITRIC OXIDE EXP GAS DETER,95012,CPT,460,RC,,,,outpatient,,,47.76,4.78,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,74.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,611,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,36.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.74,611,,facility
X-RAY XM UPR GI TRC 1CNTRST,74240,CPT,320,RC,,,,outpatient,,,218.83,21.88,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,1045.12,1045.12,1045.12,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,172.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,862.22,862.22,862.22,1 through 10,percent of total billed charges,,,33.6,,553.59,553.59,553.59,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,548.69,548.69,553.59,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,350.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,177.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,816.5,816.5,816.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,70.79,66.9,70.79,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,177.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,171.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,167.87,448,,facility
TRLUML BALO ANGIOP 1ST VEIN,37248,CPT,361,RC,,,,outpatient,,,6807.3,680.73,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2004,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,2759,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,5447.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5447.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5610.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5447.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,11384.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5773.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5447.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5773.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11062,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5556.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,11384.54,,facility
ASSAY OF ARSENIC,82175,CPT,301,RC,,,,outpatient,,,23.71,2.37,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.87,16.87,16.87,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,39.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,20.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.87,16.87,16.87,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,20.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,40.99,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.97,448,,facility
ASSAY OF MAGNESIUM,83735,CPT,301,RC,,,,outpatient,,,8.38,0.84,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.96,5.96,5.96,292,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,9.38,5.96,25.37,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,197.47,22.7,213.55,144,percent of total billed charges,,,33.6,,125.66,125.66,126.79,59,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,125.66,14.45,142.49,154,percent of total billed charges,,,34.6,,135.76,135.76,142.49,1 through 10,percent of total billed charges,,,45,,5.96,5.96,5.96,1 through 10,percent of total billed charges,,6.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,7.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,21.5,21.5,187,13,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,78.54,78.54,78.54,21,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.96,5.96,5.96,1555,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,7.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.47,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,6.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,6.7,448,,facility
SEMEN ANAL SPERM DETECTION,89321,CPT,300,RC,,,,outpatient,,,15.06,1.51,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,17.47,17.47,17.47,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.04,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.05,448,,facility
DUP-SCAN HEMO COMPL UNI STD,93986,CPT,921,RC,,,,outpatient,,,130.94,13.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1227,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,1227,,facility
ASSAY OF CALCITONIN,82308,CPT,301,RC,,,,outpatient,,,33.49,3.35,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,23.83,23.83,23.83,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,26.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,55.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,28.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,23.83,23.83,23.83,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,26.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,28.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,57.89,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,27.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,26.79,448,,facility
ASSAY OF TROPONIN QUANT,84484,CPT,301,RC,,,,outpatient,,,15.59,1.56,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.09,11.09,11.09,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,312,312,312,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,83.94,49.39,178.15,66,percent of total billed charges,,,33.6,,83.94,49.39,126.14,15,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,49.39,49.39,148.18,37,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,26.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,156,156,312,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,23.73,23.73,23.73,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.09,11.09,11.09,460,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.82,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.47,448,,facility
STRAPPING UNNA BOOT,29580,CPT,420,RC,,,,outpatient,,,187.66,18.77,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,80,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,155.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,155.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,160.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,155.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,325.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,164.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,155.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,164.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,422,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,158.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,80,448,,facility
X-RAY EXAM BREASTBONE 2/>VWS,71120,CPT,320,RC,,,,outpatient,,,108.23,10.82,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,85.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,174.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,84.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,83.29,448,,facility
CPAP INITIATION&MGMT,94660,CPT,410,RC,,,,inpatient,,,254.03,25.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Short Stay Lesser of + Days Threshold 1.00 + Stoploss First Dollar + Reimbursement Rate 57.00 + Basic Per Diem + Fixed Rate 5000.00 + Fixed Amount 157464.00,,,,0,other,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,Short Stay Lesser of + Days Threshold 1.00 + Stoploss First Dollar + Reimbursement Rate 72.00 + Basic Per Diem + Fixed Rate 10000.00 + Fixed Amount 56687.00,,,,0,other,NTE Percentage + Reimbursement Rate 85.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,47.3,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,355.93,355.93,355.93,1 through 10,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,facility
X-RAY EXAM OF FINGER(S),73140,CPT,320,RC,,,,outpatient,,,108.23,10.82,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,85.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,174.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,25.61,25.61,26.36,20,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,84.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,83.29,448,,facility
APPL CST ELBW FNGR SHORT ARM,29075,CPT,450,RC,,,,outpatient,,,319.85,31.99,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,267.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,267.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,275.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,267.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,559.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,283.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,267.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,283.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,273.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,267.68,559.45,,facility
ARTERY X-RAYS SPINE,75705,CPT,323,RC,,,,outpatient,,,6544.9,654.49,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5325.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5325.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5485.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5325.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,11130.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5645.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5325.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5645.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5432.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,443,11130.36,,facility
CLOSED TX SEPTAL&NOSE FX,21337,CPT,450,RC,,,,outpatient,,,3834.53,383.45,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3173.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3173.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3268.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3173.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,6631.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3363.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3173.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3363.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3236.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,6631.76,,facility
NSL/SINS NDSC DX MAX SINUSC,31233,CPT,761,RC,,,,outpatient,,,486.31,48.63,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,374.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,374.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,385.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,374.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,782.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,396.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,374.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,396.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,381.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,374.33,1311,,facility
I&D ABSCESS COMP/MULTIPLE,10061,CPT,761,RC,,,,outpatient,,,474.9,47.49,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,400.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,813.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,412.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,412.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,396.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,389.05,1173,,facility
CARDIOVERSION ELECTRIC EXT,92960,CPT,481,RC,,,,outpatient,,,775.13,77.51,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,574.16,574.16,582.74,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,632.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,632.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,651.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,632.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1322.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,670.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,632.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,670.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2712,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,645.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,2712,,facility
PLATE PHERES LEUKOREDU IRRAD,P9037,HCPCS,390,RC,,,,outpatient,,,840.6,84.06,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,623.23,623.23,1246.46,12,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,4380.8,4380.8,8761.6,13,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,677.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,677.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,697.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,7816.99,7816.99,7816.99,1 through 10,percent of total billed charges,,,33.6,,2299.92,2299.92,4599.84,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,4969.47,2607.94,5215.89,11,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,677.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1415.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,717.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,483.98,483.98,967.96,48,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,677.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,717.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,107,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,690.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,107,1415.52,,facility
LARYNGOSCOPY W/FB REMOVAL,31530,CPT,450,RC,,,,outpatient,,,2021.43,202.14,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1703.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1703.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1754.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1703.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3560.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1805.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1703.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1805.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1737.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3560.23,,facility
MLH1 GENE DUP/DELETE VARIANT,81294,CPT,310,RC,,,,outpatient,,,253,25.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,202.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,202.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,208.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,202.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,423.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,214.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,202.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,214.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,354.2,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,206.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,202.4,448,,facility
COLON MOTILITY 6 HR STUDY,91117,CPT,750,RC,,,,outpatient,,,373.83,37.38,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,206.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,206.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,212.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,206.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,431.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,219.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,206.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,219.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2440,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,210.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,206.65,2440,,facility
BRUCELLA ANTIBODY,86622,CPT,302,RC,,,,outpatient,,,11.16,1.12,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,18.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,9.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,7.94,7.94,7.94,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,9.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.3,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,9.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,8.93,448,,facility
CULTURE TYPING ADDED METHOD,87158,CPT,306,RC,,,,outpatient,,,9.68,0.97,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,7.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,16.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,7.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.55,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,7.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,7.74,448,,facility
PATHOGEN TEST FOR PLATELETS,P9100,HCPCS,300,RC,,,,outpatient,,,72.85,7.29,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,52.12,52.08,104.23,12,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,140.8,122.24,281.6,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,56.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,56.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,58.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,251.24,251.24,251.24,1 through 10,percent of total billed charges,,,33.6,,73.92,73.92,147.84,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,145.56,72.77,159.72,11,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,56.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,118,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,59.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,56.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,59.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,44.63,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,57.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,44.63,448,,facility
X-RAY EXAM OF HUMERUS,73060,CPT,320,RC,,,,outpatient,,,108.23,10.82,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,85.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,174.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.68,19.68,20.25,30,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,84.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,83.29,448,,facility
DRAINAGE OF NOSE LESION,30020,CPT,450,RC,,,,outpatient,,,655.29,65.53,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,516.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,516.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,531.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,516.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1078.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,547.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,516.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,547.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,526.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1173,,facility
UNLISTD PX SKN MUC MEMB SUBQ,17999,CPT,761,RC,,,,outpatient,,,238.44,23.84,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,197.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,401.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,203.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,203.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,195.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,192.01,1173,,facility
RADEX ABDOMEN 2 VIEWS,74019,CPT,320,RC,,,,outpatient,,,130.94,13.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,635.52,635.52,635.52,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,567,333.65,567,22,percent of total billed charges,,,33.6,,333.65,333.65,333.65,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,333.65,333.65,336.63,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,496.5,496.5,496.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,496.5,496.5,496.5,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,21.02,21.02,21.64,382,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,448,,facility
ASSAY OF PROTEIN URINE,84156,CPT,301,RC,,,,outpatient,,,4.59,0.46,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.26,3.26,3.26,171,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,50.15,50.15,50.15,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,14.78,14.65,44.88,32,percent of total billed charges,,,33.6,,14.78,9.41,28.56,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,9.41,9.41,28.56,36,percent of total billed charges,,,34.6,,30.85,30.85,32.38,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,7.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,13.88,3.26,42.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.26,3.26,3.26,535,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.93,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,3.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,3.67,448,,facility
ASSAY OF TRANSCORTIN,84449,CPT,301,RC,,,,outpatient,,,22.5,2.25,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,37.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.89,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18,448,,facility
SHAVE SKIN LESION 0.5 CM/<,11305,CPT,761,RC,,,,outpatient,,,238.44,23.84,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,197.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,401.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,203.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,203.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,195.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,192.01,448,,facility
ALYS SMPL SP/PN NPGT W/PRGRM,95971,CPT,920,RC,,,,outpatient,,,115.29,11.53,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,80.53,80.53,87.31,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,90.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,90.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,93.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,90.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,190.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,96.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,34.42,34.42,34.42,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,90.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,96.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,422,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,92.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,90.99,448,,facility
HEART/LUNG RESUSCITATION CPR,92950,CPT,480,RC,,,,outpatient,,,373.83,37.38,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,273.22,273.22,273.22,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,206.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,206.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,212.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,206.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,431.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,219.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,206.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,219.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1463,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,210.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,206.65,1463,,facility
DSTR CUT VSC PRLF LES>50SQCM,17108,CPT,761,RC,,,,outpatient,,,2171.91,217.19,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1974.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1974.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2033.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1974.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,4127.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2093.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1974.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2093.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,2014.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,4127.08,,facility
X-RAY EXAM RIBS UNI 2 VIEWS,71100,CPT,320,RC,,,,outpatient,,,108.23,10.82,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,85.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,174.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,21.02,21.02,21.02,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,84.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,83.29,448,,facility
RBC PRETX INCUBATJ W/CHEMICL,86970,CPT,302,RC,,,,outpatient,,,72.85,7.29,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,56.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,56.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,58.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,145.56,145.56,145.56,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,56.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,118,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,59.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,56.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,59.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,55.65,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,57.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,55.65,448,,facility
R&L HRT CATH CHD NML NT CNJ,93596,CPT,480,RC,,,,outpatient,,,3880.91,388.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2004,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,2759,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,3102.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3102.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3195.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3102.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,6484.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3288.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3102.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3288.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1463,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,3164.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,6484.66,,facility
MYCOPLASMA ANTIBODY,86738,CPT,302,RC,,,,outpatient,,,16.55,1.66,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.78,11.78,11.78,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.6,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.24,448,,facility
X-RAY EXAM OF FOOT,73630,CPT,320,RC,,,,outpatient,,,108.23,10.82,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,85.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,174.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,21.02,21.02,21.91,84,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,84.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,83.29,448,,facility
ACTINOTHERAPY UV LIGHT,96900,CPT,940,RC,,,,outpatient,,,47.76,4.78,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,34.44,34.44,37.34,114,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,74.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,418,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,36.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.74,448,,facility
OB US LIMITED FETUS(S),76815,CPT,402,RC,,,,outpatient,,,130.94,13.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,460.66,460.66,460.66,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,40.45,40.45,40.45,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,465,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,465,,facility
MAGNETIC IMAGE JAW JOINT,70336,CPT,610,RC,,,,outpatient,,,291.84,29.18,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,786,,,,,,,case rate,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,728,,,,,,,case rate,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1025,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1350,,,,,,,case rate,NTE Percentage + Reimbursement Rate 85.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,235.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,477.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,242.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,242.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2407,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,232.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,228.36,2407,,facility
CT PELVIS W/O DYE,72192,CPT,352,RC,,,,outpatient,,,130.94,13.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,93.3,93.3,93.3,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,411,411,411,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,875,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1050,,,,,,,case rate,NTE Percentage + Reimbursement Rate 85.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,1725.36,1725.36,1725.36,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,1725.36,1725.36,1725.36,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,67.98,67.98,67.98,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1522,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,1522,,facility
PANORAMIC X-RAY OF JAWS,70355,CPT,320,RC,,,,outpatient,,,108.23,10.82,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,85.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,174.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,84.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,83.29,448,,facility
DETECT AGNT MULT DNA AMPLI,87801,CPT,305,RC,,,,outpatient,,,87.75,8.78,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,70.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,70.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,72.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,70.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,146.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,74.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,70.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,74.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,151.66,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,71.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,70.2,448,,facility
SPECIAL STAINS GROUP 1,88312,CPT,310,RC,,,,outpatient,,,64.54,6.45,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,50.82,50.82,50.82,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,188.16,188.16,1128.96,16,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,173.46,173.46,173.46,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,49.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,49.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,51.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,197.57,197.57,592.7,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,49.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,104.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,52.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,69.57,69.57,72.46,29,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,49.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,52.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,78.23,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,50.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,49.87,448,,facility
DRUG ASSAY AMIODARONE,80151,CPT,301,RC,,,,outpatient,,,23.3,2.33,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.62,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.64,448,,facility
DRG XTRNL EAR ABSC/HEM SMPL,69000,CPT,761,RC,,,,outpatient,,,837.95,83.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,677.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,677.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,698.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,677.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1416.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,718.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,677.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,718.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,691.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1416.43,,facility
DSTRJ MAL LES T/A/L 1.1-2.0,17262,CPT,761,RC,,,,outpatient,,,238.44,23.84,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,174.34,174.34,174.34,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,197.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,401.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,203.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,203.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,195.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,192.01,1173,,facility
CHEMOTHERAPY INJECTION,96542,CPT,331,RC,,,,outpatient,,,403.35,40.34,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,316.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,316.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,325.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,316.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,660.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,335.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,295.37,295.37,295.37,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,316.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,335.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1603,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,322.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,316.12,1603,,facility
SHAVE SKIN LESION 1.1-2.0 CM,11302,CPT,761,RC,,,,outpatient,,,238.44,23.84,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,197.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,401.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,203.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,203.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,195.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,192.01,448,,facility
CLTX RDL HEAD/NCK FX W/MNPJ,24655,CPT,761,RC,,,,outpatient,,,1914.16,191.42,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1585.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3216.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1631.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1631.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,1569.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3216.38,,facility
DRUG ASSAY FLECAINIDE,80181,CPT,301,RC,,,,outpatient,,,23.3,2.33,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.62,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.64,448,,facility
CULTR BACTERIA EXCEPT BLOOD,87075,CPT,306,RC,,,,outpatient,,,11.84,1.18,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,8.42,8.42,8.42,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,229.49,229.49,306.67,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,229.49,229.49,229.49,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,9.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,19.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,8.42,8.42,8.42,55,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,9.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.46,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,9.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,9.47,448,,facility
TREAT PLEURODESIS W/AGENT,32560,CPT,361,RC,,,,outpatient,,,748.19,74.82,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,600.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,600.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,618.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,600.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1254.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,636.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,600.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,636.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2712,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,612.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,2712,,facility
MRI LOWER EXTREMITY W/O DYE,73718,CPT,610,RC,,,,outpatient,,,291.84,29.18,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,786,,,,,,,case rate,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,728,,,,,,,case rate,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1025,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1350,,,,,,,case rate,NTE Percentage + Reimbursement Rate 85.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,235.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,477.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,242.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,242.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2407,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,232.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,228.36,2407,,facility
NRV CNDJ TEST 9-10 STUDIES,95911,CPT,922,RC,,,,outpatient,,,638.35,63.84,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,465.55,465.55,465.55,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,357.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,357.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,367.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,357.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,746.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,378.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,68.57,68.57,68.57,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,357.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,378.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,478,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,364.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,357.13,746.4,,facility
EXC FACE-MM B9+MARG 0.5 CM/<,11440,CPT,761,RC,,,,outpatient,,,837.95,83.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,677.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,677.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,698.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,677.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1416.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,718.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,313.28,313.28,626.56,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,677.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,718.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,691.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1416.43,,facility
INJ NIVOL RELATLIMAB 3MG/1MG,J9298,HCPCS,636,RC,,,,outpatient,,,238.12,23.81,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,205.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,205.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,211.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,205.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,429.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,217.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,205.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,217.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,416.8,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,209.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,205.51,448,,facility
UNLISTED PX NERVOUS SYSTEM,64999,CPT,761,RC,,,,outpatient,,,352.75,35.28,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,293.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,293.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,302.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,293.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,613.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,311.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,293.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,311.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,299.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,293.77,1173,,facility
DIAGNOSTIC ANOSCOPY SPX,46600,CPT,750,RC,,,,outpatient,,,152.14,15.21,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,131.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,266.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,134.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,35.36,35.36,35.36,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,134.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2440,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,129.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,127.33,2440,,facility
BRCA1&2 GEN FUL DUP/DEL ALYS,81164,CPT,310,RC,,,,outpatient,,,730.29,73.03,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,584.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,584.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,601.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,584.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1221.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,619.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,584.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,619.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1022.4,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,595.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1221.04,,facility
INJ ONTRUZANT 10 MG,Q5112,HCPCS,636,RC,,,,outpatient,,,40.57,4.06,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,20.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,20.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,43.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,20.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,56.7,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,21.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,20.99,448,,facility
ASSAY OF PHENOBARBITAL,80184,CPT,301,RC,,,,outpatient,,,19.13,1.91,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,31.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.61,13.61,13.61,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.78,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,15.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,15.3,448,,facility
CULTURE SCREEN ONLY,87081,CPT,306,RC,,,,outpatient,,,8.29,0.83,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.9,5.9,5.9,191,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,192.64,5.9,192.64,17,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,277.89,277.89,277.89,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,148.9,101.14,158.93,15,percent of total billed charges,,,33.6,,148.9,101.14,158.93,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,101.14,95.6,101.14,34,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,13.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,7.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,150.5,141,150.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,63.21,63.21,63.21,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.9,5.9,5.9,279,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,7.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.32,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,6.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,6.63,448,,facility
VARICELLA-ZOSTER ANTIBODY,86787,CPT,302,RC,,,,outpatient,,,16.1,1.61,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.46,11.46,11.46,39,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,82.6,23.01,82.6,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,47.54,20.59,129.19,22,percent of total billed charges,,,33.6,,47.04,47.04,266.64,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,47.04,47.04,47.54,21,percent of total billed charges,,,34.6,,221.19,221.19,221.19,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,26.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,70,70,252.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,24.36,24.36,24.36,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,11.46,11.46,11.46,1 through 10,percent of total billed charges,,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.46,11.46,11.46,200,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.88,448,,facility
"INJECTION, FULVESTRANT",J9395,HCPCS,636,RC,,,,outpatient,,,10.91,1.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.32,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",137.25,137.25,137.25,20,other,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",14.32,448,,facility
X-RAY EXAM OF WRIST,73110,CPT,320,RC,,,,outpatient,,,108.23,10.82,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,85.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,174.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,26.69,26.69,27.47,65,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,84.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,83.29,448,,facility
SPECTROPHOTOMETRY,84311,CPT,301,RC,,,,outpatient,,,10.13,1.01,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,7.2,7.2,7.2,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,45.35,45.35,53.33,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,16.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,7.2,7.2,7.2,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.1,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,8.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,8.1,448,,facility
CONTROL OF NOSEBLEED,30901,CPT,761,RC,,,,outpatient,,,152.14,15.21,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,131.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,266.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,134.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,134.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,129.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,127.33,1173,,facility
NASAL/OROGASTRIC W/TUBE PLMT,43752,CPT,750,RC,,,,outpatient,,,474.54,47.45,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,427.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,427.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,440.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,427.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,893.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,453.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,427.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,453.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2440,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,436.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,427.54,2440,,facility
INSERT NEEDLE BONE CAVITY,36680,CPT,761,RC,,,,outpatient,,,474.54,47.45,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,427.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,427.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,440.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,427.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,893.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,453.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,427.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,453.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,436.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,427.54,1173,,facility
NJX AA&/STRD SPRSCAP NRV,64418,CPT,361,RC,,,,outpatient,,,823.63,82.36,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,675.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,675.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,695.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,675.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1411.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,716.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,675.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,716.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2712,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,689.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,2712,,facility
ASSAY OF BLOOD/URIC ACID,84550,CPT,301,RC,,,,outpatient,,,5.65,0.57,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.02,4.02,4.02,51,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,23.6,23.6,23.6,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,75.26,21.12,118.27,23,percent of total billed charges,,,33.6,,75.26,75.26,75.26,42,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,75.26,13.44,85.34,40,percent of total billed charges,,,34.6,,81.31,81.31,85.34,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,9.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,47.04,47.04,47.04,18,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.02,4.02,4.02,166,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.77,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,4.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,4.52,448,,facility
X-RAY EXAM OF KNEE 1 OR 2,73560,CPT,320,RC,,,,outpatient,,,108.23,10.82,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,85.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,174.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,21.02,21.02,21.91,57,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,84.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,83.29,448,,facility
TREAT LOWER LEG FRACTURE,27825,CPT,761,RC,,,,outpatient,,,1914.16,191.42,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1585.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3216.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1631.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1631.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,1569.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3216.38,,facility
RMVL FB MUSC/TDN SIMPLE,20520,CPT,761,RC,,,,outpatient,,,1930.94,193.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1628.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3303.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1675.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1675.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,1612.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3303.62,,facility
ECHO EXAM OF ABDOMEN,76705,CPT,402,RC,,,,outpatient,,,130.94,13.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,93.3,92.3,100.06,369,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,1141.76,1141.76,1141.76,22,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,1052.56,1052.56,1052.56,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,941.95,599.42,1018.66,44,percent of total billed charges,,,33.6,,599.42,599.42,941.95,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,599.42,599.42,604.78,43,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,892,892,892,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,892,892,892,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,47.74,47.74,49.68,268,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,465,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,465,,facility
RBC SERUM PRETX INCUBJ DRUGS,86975,CPT,302,RC,,,,outpatient,,,474.54,47.45,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,427.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,427.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,440.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,427.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,893.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,453.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,427.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,453.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,55.65,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,436.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,55.65,893.56,,facility
APPL MULTLAYER CMPRN SYS LEG,29581,CPT,420,RC,,,,outpatient,,,187.66,18.77,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,80,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,155.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,155.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,160.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,155.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,325.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,164.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,155.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,164.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,422,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,158.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,80,448,,facility
EXOME SEQUENCE ANALYSIS,81416,CPT,310,RC,,,,outpatient,,,15000,1500,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12000,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12000,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12360,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12000,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25080,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12720,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12000,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12720,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21000,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12240,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,25080,,facility
"BRACHYTX, NON-STRANDED,I-125",C2639,HCPCS,278,RC,,,,outpatient,,,43.69,4.37,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,66,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,61,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,37.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,36.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,76.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,38.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,36.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,38.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,37.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,36.46,76.2,,facility
ASSAY OF VITAMIN B-6,84207,CPT,301,RC,,,,outpatient,,,35.13,3.51,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,24.99,24.99,24.99,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,48.53,48.53,48.53,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,43.43,43.43,43.43,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,27.55,18.82,27.55,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,28.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,58.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,29.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,24.99,24.99,24.99,18,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,28.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,29.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,60.71,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,28.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,28.1,448,,facility
ALLERGEN SPECIFIC IGG,86001,CPT,302,RC,,,,outpatient,,,9.78,0.98,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,7.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,16.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,7.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.69,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,7.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,7.82,448,,facility
LANREOTIDE INJECTION,J1930,HCPCS,636,RC,,,,outpatient,,,62.53,6.25,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,37.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,37.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,78.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,39.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,39.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,96.71,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,38.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,37.43,448,,facility
HIV-2 PROBE&REVRSE TRNSCRIPJ,87538,CPT,306,RC,,,,outpatient,,,43.86,4.39,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,122.13,122.13,122.13,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
ESOPHAGOSCOPY FLEXIBLE BRUSH,43200,CPT,750,RC,,,,outpatient,,,1079.61,107.96,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,822.62,822.62,822.62,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,868.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,868.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,894.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,868.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1814.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,920.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,868.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,920.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3821,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,885.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3821,,facility
UNLISTED PROCEDURE COLON,45399,CPT,750,RC,,,,outpatient,,,1088.51,108.85,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,890.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,890.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,916.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,890.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1860.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,943.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,890.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,943.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3821,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,907.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3821,,facility
INJECTION TREATMENT OF NERVE,64640,CPT,361,RC,,,,outpatient,,,1085.56,108.56,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,846.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,846.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,871.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,846.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1769.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,897.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,846.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,897.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2712,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,863.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,2712,,facility
TIS TRNFR ANY 30.1-60 SQ CM,14301,CPT,761,RC,,,,outpatient,,,4272.83,427.28,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1027,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1519,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3391.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3391.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3493.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3391.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,7088.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3595.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3143,3143,3143,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3391.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3595.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,3459.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,7088.34,,facility
"PLASMA, FRZ BETWEEN 8-24HOUR",P9059,HCPCS,390,RC,,,,outpatient,,,90.71,9.07,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,65.57,65.57,65.57,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,73.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,73.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,579.69,579.69,579.69,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,73.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,153.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,77.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,122.32,122.32,183.48,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,73.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,77.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,107,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,74.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,73.41,448,,facility
"IMMUNE GLOBULIN, POWDER",J1566,HCPCS,636,RC,,,,outpatient,,,99.87,9.99,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,80.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,80.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,80.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,169.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,85.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,80.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,85.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,175.07,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,82.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,80.96,448,,facility
POLYSOM 6/> YRS 4/> PARAM,95810,CPT,740,RC,,,,outpatient,,,1245.23,124.52,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,892.66,758.08,892.66,77,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,6885.12,6885.12,6885.12,11,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,821.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,821.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,846.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,5680.22,5680.22,5680.22,1 through 10,percent of total billed charges,,,33.6,,5680.22,3646.96,5680.22,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,3646.96,3614.69,3646.96,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,821.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1717.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,871.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,413.57,413.57,423.13,91,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,821.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,871.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1175,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,838.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1717.69,,facility
THROMBOPLASTIN INHIBITION,85705,CPT,305,RC,,,,outpatient,,,12.04,1.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,9.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,20.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,9.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.81,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,9.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,9.63,448,,facility
THER/PROPH/DIAG IV INF ADDON,96366,CPT,260,RC,,,,outpatient,,,56.58,5.66,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,42.17,38.9,121.45,651,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,214.4,214.4,428.8,35,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,44.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,44.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,46.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,176.88,158.93,530.64,41,percent of total billed charges,,,33.6,,530.64,353.76,530.64,110,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,114.68,112.56,225.12,20,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,44.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,93.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,47.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,70.35,70.35,140.7,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,42.17,41.09,205.45,493,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,44.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,47.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,427,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,45.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,44.82,448,,facility
FETAL CHRMOML ANEUPLOIDY,81420,CPT,310,RC,,,,outpatient,,,948.81,94.88,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,675.16,675.16,675.16,181,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,1288.32,668.25,1288.32,15,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,1187.67,1187.67,1477.36,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,759.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,759.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,781.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,1062.86,676.37,1062.86,1 through 10,percent of total billed charges,,,33.6,,675.16,675.16,676.37,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,676.37,484.18,682.41,19,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,759.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1586.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,804.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,1006.5,1006.5,1006.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,593.47,593.47,593.47,1 through 10,percent of total billed charges,,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,675.16,675.16,675.16,133,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,759.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,804.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1328.34,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,774.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1586.41,,facility
CELL FUNCTION ASSAY W/STIM,86352,CPT,302,RC,,,,outpatient,,,169.83,16.98,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,135.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,135.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,139.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,210.52,210.52,210.52,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,135.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,283.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,144.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,120.85,120.85,120.85,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,135.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,144.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,293.53,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,138.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,135.86,448,,facility
ANTITHROMBIN III ANTIGEN,85301,CPT,305,RC,,,,outpatient,,,13.51,1.35,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9.62,9.62,9.62,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,95.09,95.09,95.09,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,22.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9.62,9.62,9.62,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,23.36,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,11.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,10.81,448,,facility
TREAT THUMB DISLOCATION,26641,CPT,450,RC,,,,outpatient,,,280.86,28.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,243.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,493.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,240.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,236.08,493.41,,facility
ASSAY DIR MEAS FR ESTRADIOL,82681,CPT,301,RC,,,,outpatient,,,34.93,3.49,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,27.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,58.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,29.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,27.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,29.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,48.9,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,28.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,27.94,448,,facility
ASSAY THREE CATECHOLAMINES,82384,CPT,301,RC,,,,outpatient,,,31.56,3.16,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,22.46,22.46,22.46,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,25.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,52.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,26.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,22.46,22.46,22.46,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,25.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,26.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,54.57,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,25.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,25.25,448,,facility
VENT MGMT INPAT SUBQ DAY,94003,CPT,410,RC,,,,inpatient,,,746.35,74.64,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Short Stay Lesser of + Days Threshold 1.00 + Stoploss First Dollar + Reimbursement Rate 57.00 + Basic Per Diem + Fixed Rate 5000.00 + Fixed Amount 157464.00,,,,0,other,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,Short Stay Lesser of + Days Threshold 1.00 + Stoploss First Dollar + Reimbursement Rate 72.00 + Basic Per Diem + Fixed Rate 10000.00 + Fixed Amount 56687.00,,,,0,other,NTE Percentage + Reimbursement Rate 85.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,47.3,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,641.43,641.43,641.43,1 through 10,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,facility
CONT GLUC MNTR PT PROV EQP,95249,CPT,920,RC,,,,outpatient,,,72.85,7.29,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,52.12,52.12,52.12,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,56.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,56.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,58.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,56.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,118,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,59.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,56.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,59.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,422,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,57.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,56.46,448,,facility
IMFLUOR 1ST 1ANTB STAIN PX,88346,CPT,310,RC,,,,outpatient,,,203.43,20.34,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,150.35,150.35,150.35,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,167.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,340.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,172.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,88.73,88.73,88.73,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,172.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,377,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,166.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,163.06,448,,facility
INJECTION FOR CHOLANGIOGRAM,47531,CPT,361,RC,,,,outpatient,,,4120.43,412.04,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,3426.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3426.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3529.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,1825.19,1825.19,1825.19,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3426.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,7161.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3632.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3426.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3632.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10137,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,3495.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,10137,,facility
CYSTATIN C,82610,CPT,301,RC,,,,outpatient,,,23.15,2.32,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.47,16.47,16.47,22,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,40.12,40.12,40.12,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,34.85,22.85,39.65,11,percent of total billed charges,,,33.6,,22.85,22.85,22.85,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,22.85,22.85,40,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.47,16.47,16.47,94,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.41,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.52,448,,facility
HEPATITIS A ANTIBODY,86708,CPT,302,RC,,,,outpatient,,,15.49,1.55,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.02,11.02,11.02,30,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,76.16,76.16,76.16,24,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,70.21,70.21,70.21,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,62.83,39.98,62.83,12,percent of total billed charges,,,33.6,,39.98,39.98,62.83,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,39.98,39.98,201.6,23,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,59.5,59.5,59.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.02,11.02,11.02,102,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.76,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.39,448,,facility
ASSAY DIPROPYLACETIC ACD TOT,80164,CPT,301,RC,,,,outpatient,,,16.93,1.69,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.04,12.04,12.04,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,47.04,47.04,47.04,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,28.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.04,12.04,12.04,12,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.26,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.54,448,,facility
HEMOGLOBIN FETAL,85460,CPT,305,RC,,,,outpatient,,,9.66,0.97,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,7.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,16.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,6.88,6.88,6.88,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,7.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.71,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,7.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,7.73,448,,facility
MOPATH PROCEDURE LEVEL 8,81407,CPT,310,RC,,,,outpatient,,,1057.84,105.78,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,846.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,846.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,871.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,846.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1768.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,897.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,846.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,897.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1480.97,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,863.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1768.7,,facility
ASSAY OF FOLIC ACID RBC,82747,CPT,301,RC,,,,outpatient,,,22.06,2.21,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.7,15.7,15.7,27,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,36.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.7,15.7,15.7,76,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,37.42,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.65,448,,facility
ASSAY OF TOTAL TESTOSTERONE,84403,CPT,301,RC,,,,outpatient,,,32.26,3.23,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,22.96,20,22.96,75,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,44.84,11.8,294.41,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,35.9,10.56,263.47,33,percent of total billed charges,,,33.6,,40.13,25.54,169.16,16,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,25.54,6.72,167.66,56,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,25.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,53.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,27.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,38,38,38,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,4.2,4.2,4.2,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,22.96,20,22.96,116,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,25.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,27.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,55.77,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,26.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,25.81,448,,facility
TRICHOMONAS VAGIN DIR PROBE,87660,CPT,306,RC,,,,outpatient,,,25.06,2.51,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,20.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,41.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,21.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,20.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,21.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,43.33,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,20.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,20.05,448,,facility
MYELOGRAPHY LUMBAR INJECTION,62304,CPT,361,RC,,,,outpatient,,,953.6,95.36,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,750.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,750.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,772.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,750.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1568.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,795.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,750.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,795.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2712,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,765.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,2712,,facility
BIOPSY OF TONGUE,41100,CPT,761,RC,,,,outpatient,,,655.29,65.53,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,516.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,516.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,531.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,516.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1078.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,547.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,516.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,547.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,526.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1173,,facility
ASSAY OF BLOOD CHLORIDE,82435,CPT,301,RC,,,,outpatient,,,5.75,0.58,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,9.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.09,4.09,4.09,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.94,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,4.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,4.6,448,,facility
HBA1/HBA2 GENE,81257,CPT,310,RC,,,,outpatient,,,127.83,12.78,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,102.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,102.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,105.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,102.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,213.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,108.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,102.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,108.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,178.96,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,104.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,102.26,448,,facility
EPSTEIN-BARR ANTIBODY,86663,CPT,302,RC,,,,outpatient,,,16.4,1.64,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.35,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.12,448,,facility
PML/RARALPHA COM BREAKPOINTS,81315,CPT,310,RC,,,,outpatient,,,259.14,25.91,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,184.4,184.4,184.4,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,207.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,207.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,213.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,207.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,433.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,219.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,184.4,184.4,184.4,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,207.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,219.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,447.9,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,211.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,207.31,448,,facility
CYTOGENETICS 25-99,88274,CPT,311,RC,,,,outpatient,,,52.98,5.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,43.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,42.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,88.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,44.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,42.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,44.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.22,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,43.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,42.38,448,,facility
UPR/LXTR ART STDY 3+ LVLS,93923,CPT,921,RC,,,,outpatient,,,186.04,18.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,206.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,206.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,212.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,206.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,431.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,219.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,206.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,219.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1227,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,210.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,206.65,1227,,facility
CHLAMYDIA ANTIBODY,86631,CPT,302,RC,,,,outpatient,,,14.78,1.48,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,24.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.55,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.82,448,,facility
ARTIFICIAL INSEMINATION,58322,CPT,761,RC,,,,outpatient,,,237.33,23.73,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,193.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,193.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,199.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,193.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,404.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,205.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,193.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,205.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,197.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,193.49,448,,facility
X-RAY EXAM OF NASAL BONES,70160,CPT,320,RC,,,,outpatient,,,108.23,10.82,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,85.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,290.64,290.64,290.64,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,174.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,84.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,83.29,448,,facility
IMMUNODIFFUSION OUCHTERLONY,86331,CPT,302,RC,,,,outpatient,,,14.98,1.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.66,10.66,10.66,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.88,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.98,448,,facility
MRI LUMBAR SPINE W/O DYE,72148,CPT,612,RC,,,,outpatient,,,291.84,29.18,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,212.09,210.64,228.36,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,786,,,,,,,case rate,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,728,,,,,,,case rate,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,6316.69,198.64,6316.69,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1025,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1350,,,,,,,case rate,NTE Percentage + Reimbursement Rate 85.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,235.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,4568.78,2907.41,4940.87,1 through 10,percent of total billed charges,,,33.6,,2907.41,2907.41,2907.41,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,2907.41,2907.41,2933.37,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,477.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,242.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,4326.5,4326.5,4326.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,100.61,100.61,105.76,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,242.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2407,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,232.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,228.36,2407,,facility
ASSAY OF CYANIDE,82600,CPT,301,RC,,,,outpatient,,,24.25,2.43,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,40.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,20.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,20.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,41.91,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,19.4,448,,facility
N-INVAS EAR/PLS OXIMTRY CONT,94762,CPT,460,RC,,,,outpatient,,,186.04,18.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,123.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,123.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,126.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,123.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,257.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,130.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,123.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,130.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,611,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,125.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,123.14,611,,facility
NJX AA&/STRD PUDENDAL NERVE,64430,CPT,361,RC,,,,outpatient,,,1085.56,108.56,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,846.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,846.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,871.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,846.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1769.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,897.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,846.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,897.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2712,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,863.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,2712,,facility
REM INTERROG DEV EVAL SCRMS,93298,CPT,480,RC,,,,outpatient,,,44.91,4.49,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,32.72,32.72,35.47,113,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,91.52,91.52,91.52,25,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,84.37,84.37,84.37,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,35.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,75.5,48.05,75.5,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,48.05,48.05,48.05,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,74.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,61.75,61.75,64.38,139,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1463,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,36.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.71,1463,,facility
INCISION OF EARDRUM,69420,CPT,510,RC,,,,outpatient,,,290.91,29.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1027,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1519,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,226.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,226.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,233.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,226.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,473.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,240.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,226.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,240.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,231.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,226.68,1519,,facility
EZH2 GENE FULL GENE SEQUENCE,81236,CPT,310,RC,,,,outpatient,,,353.6,35.36,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,282.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,282.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,291.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,282.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,591.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,299.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,282.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,299.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,495.04,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,288.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,282.88,591.22,,facility
CLTX POST ANKLE FX W/MNPJ,27768,CPT,450,RC,,,,outpatient,,,1914.16,191.42,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1585.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3216.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1631.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,1425.19,1425.19,1425.19,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1631.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1569.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3216.38,,facility
BIOPSY OF CERVIX,57500,CPT,761,RC,,,,outpatient,,,957.45,95.75,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,881.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,881.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,907.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,881.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1842.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,934.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,881.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,934.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,899.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1842.34,,facility
ASY HYDROXYPROGESTERONE 17-D,83498,CPT,301,RC,,,,outpatient,,,33.96,3.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,24.17,24.17,24.17,28,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,27.14,27.14,27.14,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,37.17,36.96,302.02,1 through 10,percent of total billed charges,,,33.6,,23.52,23.52,23.52,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,23.52,15.46,96.1,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,27.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,56.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,28.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,24.17,24.17,24.17,45,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,27.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,28.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,58.7,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,27.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,27.17,448,,facility
POLYSOM <6 YRS CPAP/BILVL,95783,CPT,920,RC,,,,outpatient,,,1245.23,124.52,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,892.66,892.66,892.66,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,821.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,821.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,846.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,821.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1717.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,871.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,726.83,726.83,726.83,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,821.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,871.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,422,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,838.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,422,1717.69,,facility
SHAVE SKIN LESION 0.5 CM/<,11300,CPT,761,RC,,,,outpatient,,,474.9,47.49,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,400.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,813.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,412.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,412.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,396.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,389.05,813.11,,facility
INJ OGIVRI 10 MG,Q5114,HCPCS,636,RC,,,,outpatient,,,69.73,6.97,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,7022.62,2022.72,7022.62,210,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,31.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,31.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,5821.31,4477.44,7623.3,391,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,3722.25,3449.66,5186.26,1107,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,31.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,66.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,33.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,31.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,33.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,111.46,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,32.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,31.94,448,,facility
MOPATH PROCEDURE LEVEL 9,81408,CPT,310,RC,,,,outpatient,,,2500,250,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2000,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2000,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2060,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2000,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,4180,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2120,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2000,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2120,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3500,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,2040,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,4180,,facility
SLITTING OF PREPUCE,54001,CPT,761,RC,,,,outpatient,,,2425.83,242.58,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2000.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2000.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2060.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2000.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,4181.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2120.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2000.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2120.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,2040.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,4181.3,,facility
X-RAY EXAM OF FOOT,73620,CPT,320,RC,,,,outpatient,,,108.23,10.82,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,85.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,174.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.98,16.98,17.75,11,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,84.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,83.29,448,,facility
NEEDLE EMG 4 EXTREMITIES,95864,CPT,922,RC,,,,outpatient,,,186.04,18.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,123.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,123.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,126.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,123.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,257.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,130.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,123.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,130.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,478,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,125.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,123.14,478,,facility
VOLUME DEPLETE OF HARVEST,38214,CPT,310,RC,,,,outpatient,,,517.01,51.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,422.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,422.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,434.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,655.87,655.87,655.87,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,646.56,646.56,646.56,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,422.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,882.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,447.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,422.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,447.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,430.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,422.23,882.46,,facility
ASSAY OF ASCORBIC ACID,82180,CPT,301,RC,,,,outpatient,,,12.36,1.24,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,52,52,52,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,9.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,20.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,26,26,26,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,21.42,21.42,21.42,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,8.8,8.8,8.8,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,9.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.35,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,10.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,9.89,448,,facility
DGP ANTIBODY EACH IG CLASS,86258,CPT,302,RC,,,,outpatient,,,15.06,1.51,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.72,10.72,10.72,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,10.62,10.62,10.62,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,31.58,6.1,49.63,18,percent of total billed charges,,,33.6,,6.05,6.05,6.05,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,6.05,6.05,6.1,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,9,9,9,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.72,10.72,10.72,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.18,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.05,448,,facility
CFTR GENE KNOWN FAM VARIANTS,81221,CPT,310,RC,,,,outpatient,,,121.53,12.15,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,97.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,97.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,97.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,203.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,103.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,97.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,103.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,170.14,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,99.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,97.22,448,,facility
NEUTRALIZATION TEST VIRAL,86382,CPT,302,RC,,,,outpatient,,,21.14,2.11,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,493.68,493.68,493.68,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,35.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.54,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,16.91,448,,facility
ASSAY OF PARATHORMONE,83970,CPT,301,RC,,,,outpatient,,,51.6,5.16,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,36.72,36.72,36.72,87,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,67.85,67.85,67.85,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,41.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,41.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,60.72,38.64,209.62,23,percent of total billed charges,,,33.6,,38.64,38.64,38.64,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,38.99,38.64,134.58,39,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,41.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,86.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,43.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,83.37,83.37,83.37,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,36.72,36.72,36.72,244,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,41.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,43.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,89.18,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,42.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,41.28,448,,facility
X-RAY EXAM OF LEG INFANT,73592,CPT,320,RC,,,,outpatient,,,108.23,10.82,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,85.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,174.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,84.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,83.29,448,,facility
DOPPLER FLOW TESTING,93990,CPT,921,RC,,,,outpatient,,,130.94,13.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1227,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,1227,,facility
DRAINAGE OF MOUTH LESION,41000,CPT,450,RC,,,,outpatient,,,655.29,65.53,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,516.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,516.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,531.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,516.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1078.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,547.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,516.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,547.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,526.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1173,,facility
TEST FOR URINE CYSTINES,82615,CPT,301,RC,,,,outpatient,,,11.94,1.19,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,9.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,19.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,9.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.64,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,9.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,9.55,448,,facility
ASSAY 17- KETOSTEROIDS,83586,CPT,301,RC,,,,outpatient,,,16,1.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,26.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.65,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.8,448,,facility
CLTX METATARSAL FX WO MNP EA,28470,CPT,450,RC,,,,outpatient,,,280.86,28.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,243.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,493.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,240.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,236.08,1173,,facility
MICROSOMAL ANTIBODY EACH,86376,CPT,302,RC,,,,outpatient,,,18.19,1.82,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.94,12.94,12.94,22,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,22.18,14.11,82.9,1 through 10,percent of total billed charges,,,33.6,,22.51,22.51,22.51,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,22.51,11.27,81.98,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,30.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.94,12.94,12.94,63,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,31.43,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.55,448,,facility
UNLISTED FLUOROSCOPIC PX,76496,CPT,320,RC,,,,outpatient,,,108.23,10.82,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,85.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,174.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,84.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,83.29,448,,facility
DRUG ASSAY METHOTREXATE,80204,CPT,301,RC,,,,outpatient,,,48.21,4.82,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,39.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,38.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,80.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,40.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,34.31,34.31,34.31,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,38.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,40.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,67.5,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,39.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,38.57,448,,facility
GBA GENE,81251,CPT,310,RC,,,,outpatient,,,59.06,5.91,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,47.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,47.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,48.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,47.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,98.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,50.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,47.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,50.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,82.69,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,48.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,47.25,448,,facility
ASSAY OF SWEAT SODIUM,84302,CPT,301,RC,,,,outpatient,,,6.08,0.61,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,10.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.5,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,4.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,4.86,448,,facility
SYPHILIS TEST NON-TREP QUANT,86593,CPT,302,RC,,,,outpatient,,,5.5,0.55,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.91,3.91,3.91,33,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,30.56,30.56,30.72,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,30.72,30.72,30.72,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,25.34,25.34,49.68,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,9.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.91,3.91,3.91,34,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.52,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,4.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,4.4,448,,facility
BEHAV CHNG SMOKING > 10 MIN,99407,CPT,942,RC,,,,outpatient,,,34.18,3.42,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,26.14,26.14,26.14,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,74.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,38.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,21.52,21.52,21.52,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,38.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,232,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,36.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.86,448,,facility
"INJ, FYLNETRA, 0.5 MG",Q5130,HCPCS,636,RC,,,,outpatient,,,242.58,24.26,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,105.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,105.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,108.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,105.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,219.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,111.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,105.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,111.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,394.57,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,107.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,105.11,448,,facility
PLMT URETERAL STENT PRQ,50695,CPT,361,RC,,,,outpatient,,,4151.98,415.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1027,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1519,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,3373.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3373.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3474.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3373.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,7050.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3576.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3373.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3576.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10137,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,3441.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,10137,,facility
ASSAY OF SIALIC ACID,84275,CPT,301,RC,,,,outpatient,,,16.8,1.68,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,28.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.03,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.44,448,,facility
HEPATITIS C AB TEST,86803,CPT,302,RC,,,,outpatient,,,17.84,1.78,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.69,12.69,12.69,218,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,91.45,91.45,91.45,15,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,81.84,52.08,81.84,78,percent of total billed charges,,,33.6,,52.08,52.08,81.84,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,52.08,52.08,52.46,140,percent of total billed charges,,,34.6,,48.01,16.95,50.09,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,29.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,77.5,77.38,77.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,12.69,12.69,12.69,1 through 10,percent of total billed charges,,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.69,12.69,12.69,465,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.82,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.27,448,,facility
STR MARKERS SPECIMEN ANAL,81265,CPT,310,RC,,,,outpatient,,,291.34,29.13,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,207.31,207.31,207.31,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,233.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,233.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,240.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,233.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,487.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,247.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,233.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,247.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,464.61,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,237.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,233.07,487.12,,facility
ERIBULIN MESYLATE INJECTION,J9179,HCPCS,636,RC,,,,outpatient,,,176.62,17.66,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,59.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,59.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,61.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,2450.45,2450.45,2450.45,13,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,59.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,125.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,63.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,59.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,63.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,286.64,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,61.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,59.98,448,,facility
TRANSJ CARE MGMT MOD F2F 14D,99495,CPT,510,RC,,,,outpatient,,,157.44,15.74,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,127.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,127.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,131.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,127.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,266.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,135.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,127.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,135.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,129.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,127.42,448,,facility
PROTHROMBIN TIME,85610,CPT,305,RC,,,,outpatient,,,5.36,0.54,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.82,3.82,3.82,148,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,25.6,25.6,68.48,85,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,63.13,63.13,63.13,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,35.95,16.37,61.1,101,percent of total billed charges,,,33.6,,21.12,13.44,56.5,20,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,13.56,13.44,36.27,76,percent of total billed charges,,,34.6,,38.84,38.84,40.77,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,8.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,53.5,20,141,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,22.47,8.4,22.47,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.82,3.82,3.82,801,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.49,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,4.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,4.29,448,,facility
X-RAY EXAM OF KNEE 3,73562,CPT,320,RC,,,,outpatient,,,108.23,10.82,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,85.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,174.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,25.61,25.61,26.63,56,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,84.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,83.29,448,,facility
X-RAY XM SM INT 1CNTRST STD,74250,CPT,320,RC,,,,outpatient,,,218.83,21.88,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,1379.2,1379.2,1379.2,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,1271.45,1271.45,1271.45,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,172.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,350.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,177.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,66.36,66.36,66.36,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,177.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,171.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,167.87,448,,facility
EPILEPSY GEN SEQ ALYS PANEL,81419,CPT,310,RC,,,,outpatient,,,3060.7,306.07,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2448.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2448.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2522.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2448.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,5117.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2595.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2448.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2595.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4284.98,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,2497.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,5117.49,,facility
THROMBOLYTIC VENOUS THERAPY,37212,CPT,361,RC,,,,outpatient,,,3796.26,379.63,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,3021.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3021.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3112.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3021.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,6315.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3203.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3021.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3203.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10137,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,3082.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,10137,,facility
REMOVAL OF FOREIGN BODY,27372,CPT,450,RC,,,,outpatient,,,3384.19,338.42,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2004,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,2759,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2779.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2779.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2863.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2779.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,5810.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2946.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2779.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2946.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2835.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,5810.16,,facility
ENDOSCOPY BOWEL POUCH/BIOP,44386,CPT,750,RC,,,,outpatient,,,1088.51,108.85,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,399.97,399.97,799.94,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,890.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,890.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,916.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,1392.72,1392.72,1392.72,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,890.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1860.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,943.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,890.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,943.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3821,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,907.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3821,,facility
DRUG TEST DEF SIMPLE ALL CL,G0659,HCPCS,300,RC,,,,outpatient,,,77.68,7.77,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,221.44,184.32,221.44,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,62.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,62.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,171.87,96.77,197.57,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,116.26,102.04,116.26,15,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,62.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,129.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,65.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,144,144,173,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,72.66,72.66,72.66,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,62.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,65.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,125.7,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,63.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,62.14,448,,facility
CLTX CARPL SCPHD FX W/O MNPJ,25622,CPT,450,RC,,,,outpatient,,,280.86,28.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,243.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,493.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,240.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,236.08,493.41,,facility
SIGMOIDOSCOPY W/US GUIDE BX,45342,CPT,750,RC,,,,outpatient,,,1405.45,140.55,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1179.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,1111.24,1111.24,1111.24,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,2393.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1213.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1213.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3821,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1168.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3821,,facility
PMP22 GENE DUP/DELET,81324,CPT,310,RC,,,,outpatient,,,947.95,94.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,758.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,758.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,781.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,758.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1584.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,803.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,758.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,803.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1327.13,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,773.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1584.97,,facility
NJX 1 TENDON SHEATH/LIGAMENT,20550,CPT,761,RC,,,,outpatient,,,352.75,35.28,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,293.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,293.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,302.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,293.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,613.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,311.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,293.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,311.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,299.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,293.77,1173,,facility
TREAT LOWER LEG DISLOCATION,27830,CPT,450,RC,,,,outpatient,,,280.86,28.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,243.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,493.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,240.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,236.08,1173,,facility
CLOT FACTOR XII HAGEMAN,85280,CPT,305,RC,,,,outpatient,,,24.19,2.42,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,40.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,20.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,17.21,17.21,17.21,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,20.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,41.81,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,19.35,448,,facility
TIS TRNFR F/C/C/M/N/A/G/H/F,14040,CPT,761,RC,,,,outpatient,,,2171.91,217.19,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1974.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1974.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2033.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1974.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,4127.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2093.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1974.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2093.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,2014.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,4127.08,,facility
ASSAY OF PREALBUMIN,84134,CPT,301,RC,,,,outpatient,,,18.24,1.82,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.98,12.98,12.98,37,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,47.52,47.52,166.73,1 through 10,percent of total billed charges,,,33.6,,98.11,98.11,98.11,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,30.24,30.24,98.99,16,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,30.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,18.9,18.9,18.9,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.98,12.98,12.98,128,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,31.52,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.59,448,,facility
ASSAY OF ALUMINUM,82108,CPT,301,RC,,,,outpatient,,,31.85,3.19,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,22.66,22.66,22.66,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,25.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,53.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,27.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,25.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,27.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,55.06,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,25.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,25.48,448,,facility
INS CATH REN ART 1ST UNILAT,36251,CPT,361,RC,,,,outpatient,,,3796.26,379.63,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,3021.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3021.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3112.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3021.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,6315.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3203.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3021.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3203.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10137,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,3082.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,10137,,facility
INSERT BLADDER CATH COMPLEX,51703,CPT,450,RC,,,,outpatient,,,186.04,18.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,123.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,123.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,126.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,123.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,257.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,130.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,123.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,130.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,125.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,123.14,1173,,facility
LIVER ELASTOGRAPHY,91200,CPT,510,RC,,,,outpatient,,,186.04,18.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,123.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,123.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,126.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,123.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,257.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,130.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,123.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,130.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,125.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,123.14,448,,facility
MUSCLE-SPECIFIC KINASE ANTB,86366,CPT,302,RC,,,,outpatient,,,23,2.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.37,16.37,16.37,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.2,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.4,448,,facility
WESTERN BLOT TEST,84181,CPT,301,RC,,,,outpatient,,,21.29,2.13,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,35.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.79,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.03,448,,facility
VASCULAR STUDY,93976,CPT,921,RC,,,,outpatient,,,130.94,13.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,94.7,94.7,94.7,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1227,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,1227,,facility
TREAT FINGER FRACTURE EACH,26742,CPT,761,RC,,,,outpatient,,,1914.16,191.42,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1585.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3216.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1631.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1631.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,1569.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3216.38,,facility
CLOT FACTOR X STUART-POWER,85260,CPT,305,RC,,,,outpatient,,,22.38,2.24,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,37.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.92,0.22,15.92,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.68,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.9,448,,facility
BIOPSY OF UTERUS LINING,58100,CPT,450,RC,,,,outpatient,,,237.33,23.73,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,167.93,167.93,167.93,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,193.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,193.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,199.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,193.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,404.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,205.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,193.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,205.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,197.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,193.49,1173,,facility
REMOVE HIP FOREIGN BODY,27086,CPT,450,RC,,,,outpatient,,,3384.19,338.42,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2779.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2779.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2863.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2779.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,5810.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2946.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2779.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2946.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2835.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,5810.16,,facility
TILT TABLE EVALUATION,93660,CPT,480,RC,,,,outpatient,,,638.35,63.84,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,336.03,329.42,465.55,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,357.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,357.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,367.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,357.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,746.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,378.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,472.51,472.51,472.51,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,357.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,378.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1463,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,364.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,357.13,1463,,facility
ELECTRON MICROSCOPY DX,88348,CPT,310,RC,,,,outpatient,,,1024.11,102.41,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,716.75,711.24,771.08,14,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,2202.88,1496.32,2202.88,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,771.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,771.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,794.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,771.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1611.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,817.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,337.34,337.34,341.35,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,771.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,817.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,946.68,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,786.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1611.56,,facility
THYROGLOBULIN ANTIBODY,86800,CPT,302,RC,,,,outpatient,,,19.89,1.99,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,14.15,14.15,14.15,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,19.47,19.47,92.63,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,17.42,11.09,82.9,1 through 10,percent of total billed charges,,,33.6,,41.02,41.02,52.75,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,41.02,11.09,52.75,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,33.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,14.15,14.15,14.15,30,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,34.37,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,16.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,15.91,448,,facility
ASSAY OF METANEPHRINES,83835,CPT,301,RC,,,,outpatient,,,21.18,2.12,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.07,15.07,15.07,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,32.45,32.45,32.45,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,35.28,35.28,35.28,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,35.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.07,15.07,15.07,11,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.61,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,16.94,448,,facility
F5 GENE,81241,CPT,310,RC,,,,outpatient,,,91.71,9.17,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,65.26,65.26,65.26,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,73.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,73.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,219.41,219.41,219.41,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,73.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,153.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,77.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,65.26,65.26,65.26,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,73.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,77.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,132.02,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,74.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,73.37,448,,facility
DESIGN MLC DEVICE FOR IMRT,77338,CPT,333,RC,,,,outpatient,,,440.06,44.01,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,3344.64,3083.34,3344.64,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,3083.34,3083.34,3083.34,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,358.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,358.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,369.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,2678.54,1755.94,2759.33,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,1755.94,1755.94,1755.94,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,358.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,748.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,379.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,2536.5,2536.5,2613,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,201.12,201.12,201.12,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,358.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,379.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,48815,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,365.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,358.36,48815,,facility
TREAT THIGH FRACTURE,27230,CPT,761,RC,,,,outpatient,,,280.86,28.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,243.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,493.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,240.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,236.08,1173,,facility
REMOVAL OF HEMORRHOID CLOT,46320,CPT,761,RC,,,,outpatient,,,1405.45,140.55,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1179.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,2393.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1213.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1213.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,1168.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,2393.57,,facility
X-RAY OF HAND; MINIMUM OF 3 VIEWS,73130,CPT,0320,RC,,,,outpatient,,,590,59,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,85.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,174.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,23.45,23.45,24.14,79,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,84.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,83.29,448,,facility
CYTOG ALYS CHRML ABNR CGH,81228,CPT,310,RC,,,,outpatient,,,1125,112.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,900,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,900,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,927,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,900,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1881,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,954,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,900,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,954,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1575,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,918,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1881,,facility
ASSAY OF MYOGLOBIN,83874,CPT,301,RC,,,,outpatient,,,16.15,1.62,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.49,11.49,11.49,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.91,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.92,448,,facility
GIARDIA AG IA,87329,CPT,306,RC,,,,outpatient,,,14.98,1.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.9,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.98,448,,facility
LYSE CHEST FIBRIN SUBQ DAY,32562,CPT,361,RC,,,,outpatient,,,748.19,74.82,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,600.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,600.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,618.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,600.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1254.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,636.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,600.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,636.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2712,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,612.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,2712,,facility
CARDIAC MRI FOR MORPH,75557,CPT,610,RC,,,,outpatient,,,291.84,29.18,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1025,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1350,,,,,,,case rate,NTE Percentage + Reimbursement Rate 85.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,235.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,4226.11,4226.11,4226.11,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,477.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,242.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,242.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2407,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,232.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,228.36,2407,,facility
HEPATITIS C PROBE&RVRS TRNSC,87521,CPT,306,RC,,,,outpatient,,,43.86,4.39,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
AR GENE KNOWN FAMIL VARIANT,81174,CPT,310,RC,,,,outpatient,,,231.5,23.15,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,185.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,185.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,190.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,185.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,387.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,196.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,185.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,196.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,324.1,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,188.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,185.2,448,,facility
ESOPHAGOSCOPY FLEX REMOVE FB,43215,CPT,750,RC,,,,outpatient,,,2266.24,226.62,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,1836.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1836.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1891.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1836.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3838.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1946.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1836.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1946.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3821,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1873.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3838.31,,facility
COLONOSCOPY W/RESECTION,44403,CPT,750,RC,,,,outpatient,,,1405.45,140.55,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1179.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,2393.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1213.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1213.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3821,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1168.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3821,,facility
NASAL ENDOSCOPY DX,31231,CPT,761,RC,,,,outpatient,,,235.91,23.59,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,191.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,191.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,196.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,191.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,399.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,202.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,172.88,172.88,172.88,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,191.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,202.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,194.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,191.04,1311,,facility
RMVL OF SUBQ DEFIBRILLATOR,33272,CPT,361,RC,,,,outpatient,,,4677.03,467.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1027,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1519,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,3576.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3576.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3683.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3576.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,7474.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3791.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3576.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3791.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10137,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,3648.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,10137,,facility
NJX AA&/STRD SCIATIC NRV IMG,64445,CPT,361,RC,,,,outpatient,,,823.63,82.36,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,675.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,675.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,695.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,675.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1411.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,716.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,675.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,716.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2712,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,689.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,2712,,facility
UNLISTED PROCEDURE NOSE,30999,CPT,450,RC,,,,outpatient,,,290.91,29.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,203.75,203.75,203.75,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,226.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,226.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,233.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,226.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,473.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,240.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,226.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,240.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,231.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,226.68,1173,,facility
REPTILASE TEST,85635,CPT,305,RC,,,,outpatient,,,12.31,1.23,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,9.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,20.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,9.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.28,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,10.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,9.85,448,,facility
BRIEF EMOTIONAL/BEHAV ASSMT,96127,CPT,918,RC,,,,outpatient,,,47.76,4.78,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,74.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1372,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,36.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.74,1372,,professional
ASSAY OF TOBRAMYCIN,80200,CPT,301,RC,,,,outpatient,,,20.16,2.02,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,33.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,34.84,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,16.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,16.13,448,,facility
IRRG CRPRA CAVRNOSA PRIAPISM,54220,CPT,450,RC,,,,outpatient,,,294.35,29.44,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,213.4,213.4,213.4,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,239.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,239.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,246.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,239.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,499.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,253.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,239.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,253.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,243.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,239.12,1173,,facility
COLL VENOUS BLD VENIPUNCTURE,36415,CPT,300,RC,,,,outpatient,,,11.04,1.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,8.09,8.09,8.31,58,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,10.91,9.28,57.6,227,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,12.73,8.56,79.9,21,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,90,90,90,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,51.39,30.24,51.39,230,percent of total billed charges,,,33.6,,30.24,5.04,51.39,24,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,30.24,30.24,30.51,106,percent of total billed charges,,,34.6,,32.69,32.69,32.69,1 through 10,percent of total billed charges,,,45,,8.09,8.09,8.09,1 through 10,percent of total billed charges,,9.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,19.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,9.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,7.5,7.25,45,119,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,18.9,3.15,18.9,49,percent of total billed charges,,,35,,45,45,45,1 through 10,percent of total billed charges,,,40,,15,8.09,90,1 through 10,percent of total billed charges,,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,8.09,8.09,8.31,11157,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,9.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,9.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.25,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,9.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.25,448,,facility
MYCOPLASMA,87109,CPT,306,RC,,,,outpatient,,,19.24,1.92,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.69,13.69,13.69,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,32.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.69,13.69,13.69,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,33.25,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,15.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,15.39,448,,facility
INTMD RPR FACE/MM 2.6-5.0 CM,12052,CPT,761,RC,,,,outpatient,,,474.9,47.49,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,179.43,175.27,183.04,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,400.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,813.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,412.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,355.79,355.79,355.79,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,412.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,396.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,389.05,1173,,facility
TREAT FINGER DISLOCATION,26770,CPT,761,RC,,,,outpatient,,,280.86,28.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,243.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,493.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,240.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,236.08,493.41,,facility
MRI UPPER EXTREMITY W/O DYE,73218,CPT,610,RC,,,,outpatient,,,291.84,29.18,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,786,,,,,,,case rate,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,728,,,,,,,case rate,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1025,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1350,,,,,,,case rate,NTE Percentage + Reimbursement Rate 85.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,235.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,477.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,242.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,242.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2407,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,232.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,228.36,2407,,facility
REMOVAL OF FOOT FOREIGN BODY,28192,CPT,450,RC,,,,outpatient,,,1930.94,193.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1628.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3303.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1675.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1675.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1612.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3303.62,,facility
CFTR GENE INTRON POLY T,81224,CPT,310,RC,,,,outpatient,,,210.94,21.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,168.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,168.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,173.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,168.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,352.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,178.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,168.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,178.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,295.31,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,172.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,168.75,448,,facility
FIBRINOLYTIC PLASMINOGEN,85421,CPT,305,RC,,,,outpatient,,,12.73,1.27,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,21.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,10.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,10.18,448,,facility
HIV-1 PROBE&REVERSE TRNSCRPJ,87535,CPT,306,RC,,,,outpatient,,,43.86,4.39,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,122.13,122.13,122.13,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,38.98,38.98,61.25,1 through 10,percent of total billed charges,,,33.6,,618.82,618.82,618.82,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,38.48,38.48,42.11,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
COMPREHEN METABOLIC PANEL,80053,CPT,301,RC,,,,outpatient,,,13.2,1.32,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9.39,9.39,9.39,1527,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,30.68,30.68,604.75,68,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,33.28,33.28,33.28,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,27.46,17.47,585.27,705,percent of total billed charges,,,33.6,,344.4,17.47,541.2,199,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,17.63,17.47,347.48,855,percent of total billed charges,,,34.6,,372.07,42.7,390.52,33,percent of total billed charges,,,45,,9.39,9.39,9.39,1 through 10,percent of total billed charges,,10.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,22.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,26,26,512.5,60,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,215.25,10.92,215.25,37,percent of total billed charges,,,35,,512.5,512.5,512.5,1 through 10,percent of total billed charges,,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9.39,9.39,9.39,5909,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.82,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,10.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,10.56,448,,facility
INTMD RPR S/TR/EXT >30.0 CM,12037,CPT,450,RC,,,,outpatient,,,2171.91,217.19,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1974.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1974.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2033.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1974.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,4127.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2093.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1974.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2093.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2014.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,4127.08,,facility
PERQ LUMBOSACRAL INJECTION,22511,CPT,320,RC,,,,outpatient,,,3855.04,385.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1268,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1793,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3131.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3131.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3225.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3131.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,6544.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3319.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3131.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3319.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,3194.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,443,6544.81,,facility
CFTR GENE FULL SEQUENCE,81223,CPT,310,RC,,,,outpatient,,,623.75,62.38,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,499,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,499,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,513.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,499,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1042.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,528.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,499,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,528.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,873.25,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,508.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1042.91,,facility
EGD DIAGNOSTIC BRUSH WASH,43235,CPT,750,RC,,,,outpatient,,,1079.61,107.96,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,770.12,408.37,822.62,24,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,868.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,868.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,894.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,868.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1814.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,920.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,834.91,417.46,834.91,22,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,868.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,920.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3821,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,885.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3821,,facility
COLONOSCOPY WITH BIOPSY,44389,CPT,750,RC,,,,outpatient,,,1405.45,140.55,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1179.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,2393.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1213.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1213.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3821,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1168.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3821,,facility
MASTOTOMY EXPL DRG ABSC DP,19020,CPT,761,RC,,,,outpatient,,,1930.94,193.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1628.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3303.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1675.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1675.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,1612.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3303.62,,facility
EXTRACRANIAL BILAT STUDY,93880,CPT,921,RC,,,,outpatient,,,291.84,29.18,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,235.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,477.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,242.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,242.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1227,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,232.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,228.36,1227,,facility
MRI CHEST SPINE W/O DYE,72146,CPT,612,RC,,,,outpatient,,,291.84,29.18,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,464.74,464.74,474.04,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,786,,,,,,,case rate,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,728,,,,,,,case rate,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,6419.62,99.15,6419.62,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1025,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1350,,,,,,,case rate,NTE Percentage + Reimbursement Rate 85.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,235.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,4643.23,4643.23,5021.37,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,2954.78,2954.78,2954.78,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,477.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,242.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,4397,4397,4397,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,100.34,100.34,100.34,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,242.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2407,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,232.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,228.36,2407,,facility
CAMPYLOBACTER ANTIBODY,86625,CPT,302,RC,,,,outpatient,,,16.4,1.64,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.35,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.12,448,,facility
I&D UPR A/E BURSA,23931,CPT,450,RC,,,,outpatient,,,1930.94,193.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1628.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3303.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1675.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1675.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1612.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3303.62,,facility
COLON CA SCRN NOT HI RSK IND,G0121,HCPCS,750,RC,,,,outpatient,,,1088.51,108.85,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,890.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,890.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,916.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,1633.63,1633.63,1633.63,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,890.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1860.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,943.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,890.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,943.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2712,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,907.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,2712,,facility
BIOPSY LOWER LEG SOFT TISSUE,27613,CPT,361,RC,,,,outpatient,,,1930.94,193.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1628.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3303.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1675.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1675.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2712,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1612.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3303.62,,facility
CARCINOEMBRYONIC ANTIGEN,82378,CPT,301,RC,,,,outpatient,,,23.7,2.37,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.86,16.86,16.86,25,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,89.04,28.9,139.92,41,percent of total billed charges,,,33.6,,89.04,28.9,89.04,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,28.9,28.9,89.04,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,39.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,20.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,132.5,132.5,132.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.86,16.86,16.86,36,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,20.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,40.97,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.96,448,,facility
CHEMOTX ADMN PERTL CAV IMPL,96446,CPT,331,RC,,,,outpatient,,,403.35,40.34,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,316.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,316.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,325.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,316.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,660.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,335.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,316.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,335.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1603,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,322.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,316.12,1603,,facility
EMBRYO TRANSFER INTRAUTERINE,58974,CPT,761,RC,,,,outpatient,,,957.45,95.75,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,881.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,881.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,907.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,881.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1842.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,934.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,881.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,934.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,899.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1842.34,,facility
SHAVE SKIN LESION >2.0 CM,11308,CPT,761,RC,,,,outpatient,,,474.9,47.49,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,400.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,813.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,412.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,412.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,396.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,389.05,813.11,,facility
RHYTHM ECG TRACING,93041,CPT,730,RC,,,,outpatient,,,72.85,7.29,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,56.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,56.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,58.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,56.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,118,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,59.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,56.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,59.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,389,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,57.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,56.46,448,,facility
APHERESIS PLASMA,36514,CPT,940,RC,,,,outpatient,,,1827.36,182.74,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1490.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1490.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1535.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1490.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3115.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1579.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1490.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1579.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,418,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1520.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,418,3115.25,,facility
EXOME RE-EVALUATION,81417,CPT,310,RC,,,,outpatient,,,400,40,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,320,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,320,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,329.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,320,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,668.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,339.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,320,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,339.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,560,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,326.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,320,668.8,,facility
CLTX CARPL FX W/O MNPJ EA B1,25630,CPT,450,RC,,,,outpatient,,,280.86,28.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,243.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,493.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,240.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,236.08,1173,,facility
MACROSCOPIC EXAM PARASITE,87169,CPT,306,RC,,,,outpatient,,,5.39,0.54,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,9.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.22,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,4.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,4.31,448,,facility
HEXAGNAL PHOSPH PLTLT NEUTRL,85598,CPT,305,RC,,,,outpatient,,,22.48,2.25,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.99,15.99,15.99,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,168.32,168.32,168.32,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,37.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.98,448,,facility
INSERT BLADDER CATHETER,51701,CPT,761,RC,,,,outpatient,,,152.14,15.21,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,131.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,266.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,134.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,134.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,129.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,127.33,1173,,facility
ALPHA-1-ANTITRYPSIN PHENO,82104,CPT,301,RC,,,,outpatient,,,18.08,1.81,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10,10,12.86,11,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,16.46,16.46,25.87,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,3.36,3.36,3.36,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,30.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10,10,12.86,42,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,31.26,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.46,448,,facility
RPR F/E/E/N/L/M >30.0 CM,12018,CPT,450,RC,,,,outpatient,,,238.44,23.84,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,197.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,401.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,203.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,203.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,195.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,192.01,1311,,facility
OCCULT BLOOD FECES,82270,CPT,301,RC,,,,outpatient,,,5.48,0.55,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,9.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.67,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,4.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,4.38,448,,facility
LEUKOCYTE ASSESSMENT FECAL,89055,CPT,309,RC,,,,outpatient,,,5.34,0.53,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,8.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.22,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,4.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,4.27,448,,facility
EPSTEIN-BARR CAPSID VCA,86665,CPT,302,RC,,,,outpatient,,,22.68,2.27,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.14,16.14,16.14,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,106.24,61.44,106.24,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,87.65,87.65,759.96,1 through 10,percent of total billed charges,,,33.6,,345.41,345.41,345.41,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,65.86,65.86,345.41,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,37.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.14,16.14,16.14,21,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,39.2,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.14,448,,facility
PINWORM EXAM,87172,CPT,306,RC,,,,outpatient,,,5.34,0.53,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,8.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.22,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,4.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,4.27,448,,facility
NJX PX NFROSGRM &/URTRGRM,50430,CPT,361,RC,,,,outpatient,,,813.58,81.36,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,667.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,667.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,687.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,667.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1394.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,707.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,667.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,707.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2712,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,680.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,2712,,facility
HEP B SURFACE ANTIBODY,86706,CPT,302,RC,,,,outpatient,,,13.43,1.34,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,33.73,33.73,33.73,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,22.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9.55,9.55,9.55,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,23.21,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,10.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,10.74,448,,facility
MYD88 GENE P.LEU265PRO VRNT,81305,CPT,310,RC,,,,outpatient,,,219.25,21.93,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,175.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,175.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,180.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,175.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,366.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,185.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,175.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,185.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,306.95,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,178.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,175.4,448,,facility
B CELLS TOTAL COUNT,86355,CPT,302,RC,,,,outpatient,,,47.16,4.72,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,33.56,33.56,33.56,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,60.77,60.77,60.77,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,37.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,37.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,27.98,27.98,27.98,1 through 10,percent of total billed charges,,,33.6,,33.56,33.56,33.56,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,63.63,63.63,63.63,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,78.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,39.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,33.56,33.56,33.56,25,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,39.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,81.52,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,38.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,37.73,448,,facility
BIOPSY VAGINAL MUCOSA XTNSV,57105,CPT,761,RC,,,,outpatient,,,3723.46,372.35,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3098.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3098.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3191.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3098.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,6475.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3284,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3098.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3284,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,3160.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,6475.05,,facility
DX BRONCHOSCOPE/WASH,31622,CPT,750,RC,,,,outpatient,,,2021.43,202.14,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,1703.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1703.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1754.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1703.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3560.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1805.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1703.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1805.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3821,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1737.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3821,,facility
BACTERIUM ANTIBODY,86609,CPT,302,RC,,,,outpatient,,,16.1,1.61,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,26.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.88,448,,facility
ENDOCERVICAL CURETTAGE,57505,CPT,761,RC,,,,outpatient,,,957.45,95.75,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,775.41,775.41,775.41,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,881.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,881.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,907.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,881.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1842.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,934.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,881.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,934.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,899.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1842.34,,facility
EXPLORE/TREAT FINGER JOINT,26075,CPT,450,RC,,,,outpatient,,,3855.04,385.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1268,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1793,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3131.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3131.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3225.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3131.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,6544.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3319.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3131.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3319.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3194.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,6544.81,,facility
CHLMYD TRACH DNA AMP PROBE,87491,CPT,306,RC,,,,outpatient,,,43.86,4.39,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,442,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,20.65,20.65,65.49,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,232.32,232.32,232.32,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,37.3,18.48,58.61,62,percent of total billed charges,,,33.6,,37.3,11.76,63.38,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,28.82,11.76,37.3,69,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,42.5,17.5,55.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,23.31,23.31,23.31,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,31.21,31.21,31.21,1 through 10,percent of total billed charges,,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,796,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
BIOPSY LOWER LEG SOFT TISSUE,27614,CPT,361,RC,,,,outpatient,,,3384.19,338.42,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,2779.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2779.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2863.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2779.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,5810.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2946.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2779.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2946.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9389,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,2835.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,9389,,facility
NEEDLE EMG 2 EXTREMITIES,95861,CPT,922,RC,,,,outpatient,,,152.14,15.21,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,131.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,266.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,134.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,134.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,478,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,129.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,127.33,478,,facility
DXA BONE DENSITY AXIAL,77080,CPT,320,RC,,,,outpatient,,,130.94,13.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,39.86,39.86,39.86,32,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,39.86,39.86,39.86,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,151.2,57.61,237.6,26,percent of total billed charges,,,33.6,,57.61,57.61,57.61,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,117.29,57.61,151.2,15,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,448,,facility
REMOVE VAGINAL FOREIGN BODY,57415,CPT,761,RC,,,,outpatient,,,3723.46,372.35,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3098.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3098.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3191.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3098.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,6475.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3284,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3098.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3284,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,3160.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,6475.05,,facility
ASSAY OF PHOSPHORUS,84100,CPT,301,RC,,,,outpatient,,,5.93,0.59,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.22,4.22,4.22,190,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,19.82,7.39,33.69,48,percent of total billed charges,,,33.6,,19.82,19.82,19.82,43,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,18.67,4.66,19.82,49,percent of total billed charges,,,34.6,,21.42,18.67,22.48,1 through 10,percent of total billed charges,,,45,,4.22,4.22,4.22,1 through 10,percent of total billed charges,,4.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,9.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,7,7,29.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,12.39,12.39,12.39,13,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.22,4.22,4.22,740,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.24,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,4.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,4.74,448,,facility
INJECT EPIDURAL PATCH,62273,CPT,361,RC,,,,outpatient,,,823.63,82.36,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,623.15,623.15,623.15,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,675.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,675.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,695.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,675.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1411.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,716.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,616.7,616.7,616.7,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,675.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,716.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2712,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,689.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,2712,,facility
ENCEPHALTIS EAST EQNE ANBDY,86652,CPT,302,RC,,,,outpatient,,,16.49,1.65,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.49,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.19,448,,facility
ASSAY OF CALCIUM,82330,CPT,301,RC,,,,outpatient,,,17.1,1.71,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.17,12.17,12.17,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,85.31,18.14,138.18,19,percent of total billed charges,,,33.6,,81.31,81.31,81.31,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,64.41,18.14,81.31,24,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,28.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,50.82,50.82,50.82,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.17,12.17,12.17,185,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.54,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.68,448,,facility
CLTX ULNAR STYLOID FRACTURE,25650,CPT,761,RC,,,,outpatient,,,280.86,28.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,243.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,493.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,240.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,236.08,493.41,,facility
BLOOD GASES W/O2 SATURATION,82805,CPT,301,RC,,,,outpatient,,,98.46,9.85,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,78.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,78.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,81.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,156.58,156.58,266.09,1 through 10,percent of total billed charges,,,33.6,,188.4,188.4,188.4,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,156.58,156.58,156.58,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,78.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,164.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,83.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,70.06,70.06,70.06,25,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,78.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,83.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,137.85,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,80.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,78.77,448,,facility
PHENOTYPE INFECT AGENT DRUG,87900,CPT,306,RC,,,,outpatient,,,162.94,16.29,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,130.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,130.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,134.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,130.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,272.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,138.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,130.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,138.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,281.61,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,132.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,130.35,448,,facility
"INJECTION, PERTUZUMAB, 1 MG",J9306,HCPCS,636,RC,,,,outpatient,,,19.93,1.99,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,14124.6,14124.6,14124.6,420,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,17.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,12640.32,12640.32,12640.32,840,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,8115.66,8115.66,8115.66,420,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,35.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,34.81,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.2,448,,facility
CLTX MONTEGGIA FX DISLC ELBW,24620,CPT,761,RC,,,,outpatient,,,1914.16,191.42,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1585.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3216.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1631.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1631.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,1569.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3216.38,,facility
REMOVAL OF SPERM DUCT(S),55250,CPT,761,RC,,,,outpatient,,,2425.83,242.58,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2000.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2000.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2060.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2000.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,4181.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2120.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2000.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2120.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,2040.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,4181.3,,facility
CFTR GENE COM VARIANTS,81220,CPT,310,RC,,,,outpatient,,,695.75,69.58,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,495.09,495.09,495.09,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,556.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,556.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,573.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,1875.98,1875.98,1875.98,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,1193.81,1193.81,1204.47,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,556.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1163.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,590,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,495.09,495.09,495.09,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,556.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,590,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,974.05,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,567.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1163.29,,facility
CHEMO PROLONG INFUSE W/PUMP,96416,CPT,335,RC,,,,outpatient,,,403.35,40.34,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,291.03,272.45,295.37,141,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,1009.28,930.43,1009.28,31,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,316.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,316.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,325.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,529.87,529.87,832.66,32,percent of total billed charges,,,33.6,,529.87,529.87,529.87,22,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,529.87,529.87,529.87,11,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,316.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,660.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,335.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,295.37,295.37,297.44,40,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,316.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,335.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1603,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,322.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,316.12,1603,,facility
HEPARIN NEUTRALIZATION,85525,CPT,305,RC,,,,outpatient,,,14.8,1.48,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,24.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.59,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.84,448,,facility
ANTI-PHOSPHOLIPID ANTIBODY,86148,CPT,302,RC,,,,outpatient,,,20.09,2.01,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,14.29,14.29,14.29,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,33.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,34.72,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,16.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,16.07,448,,facility
RPR FE/E/EN/L/M 20.1-30.0 CM,12017,CPT,450,RC,,,,outpatient,,,474.9,47.49,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,400.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,813.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,412.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,412.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,396.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,389.05,1311,,facility
X-RAY XM SM INT 2CNTRST STD,74251,CPT,320,RC,,,,outpatient,,,218.83,21.88,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,172.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,350.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,177.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,177.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,171.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,167.87,448,,facility
HFE GENE,81256,CPT,310,RC,,,,outpatient,,,81.7,8.17,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,58.14,58.14,58.14,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,65.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,65.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,67.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,65.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,136.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,69.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,65.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,69.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,141.21,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,66.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,65.36,448,,facility
TRANSPLJ HEMATOPOIETIC BOOST,38243,CPT,761,RC,,,,outpatient,,,1827.36,182.74,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1490.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1490.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1535.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1490.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3115.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1579.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1490.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1579.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,1520.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3115.25,,facility
MYCOBACTERIA CULTURE,87116,CPT,306,RC,,,,outpatient,,,13.5,1.35,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9.61,9.61,9.61,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,22.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9.61,9.61,9.61,23,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,23.35,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,11.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,10.8,448,,facility
ASSAY OF CALCIUM IN URINE,82340,CPT,301,RC,,,,outpatient,,,7.54,0.75,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.36,5.36,5.36,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,19.15,19.15,123.98,1 through 10,percent of total billed charges,,,33.6,,123.98,123.98,123.98,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,19.15,19.15,19.15,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,12.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.36,5.36,5.36,54,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.02,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,6.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,6.03,448,,facility
GJB2 GENE FULL SEQUENCE,81252,CPT,310,RC,,,,outpatient,,,126.4,12.64,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,101.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,101.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,104.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,101.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,211.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,107.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,101.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,107.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,176.96,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,103.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,101.12,448,,facility
I&D BARTHOLINS GLAND ABSCESS,56420,CPT,761,RC,,,,outpatient,,,237.33,23.73,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,193.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,193.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,199.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,193.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,404.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,205.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,193.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,205.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,197.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,193.49,1173,,facility
RIGHT HEART CATH,93451,CPT,480,RC,,,,outpatient,,,3880.91,388.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,2822.09,2822.09,2822.09,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,3102.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3102.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3195.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3102.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,6484.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3288.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,557.68,0.14,602.26,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3102.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3288.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1463,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,3164.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,669,6484.66,,facility
R&L HRT ART/VENTRICLE ANGIO,93461,CPT,480,RC,,,,outpatient,,,3880.91,388.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2004,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,2759,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,3102.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3102.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3195.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3102.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,6484.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3288.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3102.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3288.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1463,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,3164.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,1463,6484.66,,facility
STRAPPING OF HIP,29520,CPT,450,RC,,,,outpatient,,,152.14,15.21,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,131.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,266.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,134.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,134.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,129.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,127.33,448,,facility
TX/PROPH/DG ADDL SEQ IV INF,96367,CPT,260,RC,,,,outpatient,,,83.9,8.39,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,63.38,58.46,129.68,797,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,220.16,188.8,660.48,144,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,202.96,202.96,202.96,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,68.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,68.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,70.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,181.63,115.58,363.26,110,percent of total billed charges,,,33.6,,115.58,115.58,115.58,17,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,115.58,100.01,200.01,64,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,68.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,144.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,73.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,172,172,172,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,144.48,144.48,144.48,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,64.84,63.38,126.76,353,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,68.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,73.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,427,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,70.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,68.91,448,,facility
ALPHA-1-ANTITRYPSIN TOTAL,82103,CPT,301,RC,,,,outpatient,,,16.8,1.68,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.95,11.95,11.95,14,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,15.79,11.42,30.1,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,19.15,11.42,48.05,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,28.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.95,11.95,11.95,58,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.03,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.44,448,,facility
TREATMENT OF TOE FRACTURE,28515,CPT,761,RC,,,,outpatient,,,280.86,28.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,243.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,493.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,240.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,236.08,1173,,facility
DEPRESSION SCREEN ANNUAL,G0444,HCPCS,510,RC,,,,outpatient,,,34.18,3.42,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,74.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,38.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,38.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,36.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.86,448,,facility
CHEMOTHERAPY INTO CNS,96450,CPT,331,RC,,,,outpatient,,,403.35,40.34,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,291.03,272.45,297.44,28,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,1198.72,1198.72,1198.72,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,316.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,316.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,325.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,316.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,660.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,335.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,393.33,393.33,393.33,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,295.37,295.37,295.37,29,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,316.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,335.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1603,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,322.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,316.12,1603,,facility
GROWTH HORMONE ANTIBODY,86277,CPT,302,RC,,,,outpatient,,,19.68,1.97,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,32.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,34,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,16.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,15.74,448,,facility
RPR F/E/E/N/L/M 2.6-5.0 CM,12013,CPT,761,RC,,,,outpatient,,,238.44,23.84,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,197.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,401.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,203.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,203.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,195.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,192.01,448,,facility
INTMD RPR N-HF/GENIT20.1-30,12046,CPT,450,RC,,,,outpatient,,,748,74.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,707.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,707.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,728.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,707.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1478.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,749.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,707.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,749.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,721.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1478.34,,facility
APPLICATION SHORT LEG SPLINT,29515,CPT,450,RC,,,,outpatient,,,187.66,18.77,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,138.44,138.44,138.44,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,155.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,155.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,160.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,155.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,325.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,164.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,155.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,164.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,158.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,155.52,448,,facility
TREAT ANKLE DISLOCATION,27840,CPT,761,RC,,,,outpatient,,,280.86,28.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,243.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,493.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,240.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,236.08,1173,,facility
ASSAY OF SEX HORMONE GLOBUL,84270,CPT,301,RC,,,,outpatient,,,27.16,2.72,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.33,19.33,19.33,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,168.43,168.43,182.15,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,108.14,107.18,108.14,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,21.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,45.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,23.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.33,19.33,19.33,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,21.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,23.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,46.95,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,22.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,21.73,448,,facility
X-RAY NOSE TO RECTUM,76010,CPT,320,RC,,,,outpatient,,,108.23,10.82,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,574.08,574.08,574.08,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,85.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,512.19,445.38,512.19,1 through 10,percent of total billed charges,,,33.6,,301.39,301.39,301.39,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,301.39,301.39,301.39,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,174.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,448.5,448.5,448.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.71,16.71,17.47,38,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,84.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,83.29,448,,facility
UGT1A1 GENE COMMON VARIANTS,81350,CPT,310,RC,,,,outpatient,,,292.5,29.25,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,234,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,234,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,241.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,234,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,489.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,248.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,234,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,248.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,409.5,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,238.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,234,489.06,,facility
BARTONELLA DNA AMP PROBE,87471,CPT,306,RC,,,,outpatient,,,43.86,4.39,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
IRRIG DRUG DELIVERY DEVICE,96523,CPT,335,RC,,,,outpatient,,,72.85,7.29,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,52.12,52.12,56.5,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,56.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,56.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,58.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,56.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,118,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,59.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,56.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,59.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1603,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,57.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,56.46,1603,,facility
CYP2C9 GENE COM VARIANTS,81227,CPT,310,RC,,,,outpatient,,,218.51,21.85,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,174.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,174.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,180.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,174.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,365.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,185.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,174.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,185.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,305.92,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,178.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,174.81,448,,facility
"INJECTION, UDENYCA 0.5 MG",Q5111,HCPCS,636,RC,,,,outpatient,,,207.56,20.76,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,9853.44,9853.44,9853.44,12,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,149.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,149.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,153.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,8129.09,5219.24,8129.09,132,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,5219.24,5219.24,5219.24,12,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,149.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,311.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,158.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,149.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,158.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,291.43,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,152.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,149.13,448,,facility
ACUTE HEPATITIS PANEL,80074,CPT,302,RC,,,,outpatient,,,59.54,5.95,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,42.37,42.37,42.37,53,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,102.07,102.07,319.78,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,47.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,47.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,49.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,91.34,58.13,309.48,14,percent of total billed charges,,,33.6,,91.48,91.48,91.48,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,58.13,58.13,58.73,15,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,47.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,99.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,50.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,42.37,42.37,42.37,95,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,47.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,50.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,102.92,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,48.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,47.63,448,,facility
ASSAY OF GONADOTROPIN (LH),83002,CPT,301,RC,,,,outpatient,,,23.15,2.32,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.47,16.47,16.47,47,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,174.64,174.64,174.64,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,45.41,45.28,156.29,14,percent of total billed charges,,,33.6,,45.41,29.07,99.46,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,28.9,28.9,99.46,15,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,43,43,43,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,18.06,18.06,18.06,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.47,16.47,16.47,101,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,40.01,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.52,448,,facility
ADENOVIRUS AG IA,87301,CPT,306,RC,,,,outpatient,,,14.98,1.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.9,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.98,448,,facility
MOPATH PROCEDURE LEVEL 1,81400,CPT,310,RC,,,,outpatient,,,79.95,8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,63.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,63.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,65.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,63.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,133.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,67.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,63.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,67.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,111.93,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,65.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,63.96,448,,facility
STRAPPING OF KNEE,29530,CPT,761,RC,,,,outpatient,,,152.14,15.21,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,131.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,266.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,134.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,134.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,129.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,127.33,448,,facility
HUMAN EPIDIDYMIS PROTEIN 4,86305,CPT,302,RC,,,,outpatient,,,26.01,2.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,20.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,43.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,20.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,44.98,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,21.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,20.81,448,,facility
THER SPI PNXR DRG CSF,62272,CPT,761,RC,,,,outpatient,,,823.63,82.36,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,675.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,675.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,695.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,675.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1411.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,716.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,675.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,716.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,689.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1411.94,,facility
PULMONARY STRESS TESTING,94618,CPT,460,RC,,,,outpatient,,,152.14,15.21,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,248.32,248.32,248.32,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,131.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,204.86,130.37,204.86,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,266.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,134.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.23,10.23,10.25,15,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,134.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,611,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,129.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,127.33,611,,facility
TYMPANOMETRY,92567,CPT,471,RC,,,,outpatient,,,47.76,4.78,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,74.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,425,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,36.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.74,448,,facility
NDL EMG THRC PARASPINAL MUSC,95869,CPT,922,RC,,,,outpatient,,,373.83,37.38,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,206.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,206.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,212.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,206.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,431.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,219.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,206.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,219.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,478,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,210.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,206.65,478,,facility
ENZYME HISTOCHEMISTRY,88319,CPT,312,RC,,,,outpatient,,,1024.11,102.41,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,771.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,771.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,794.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,771.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1611.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,817.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,771.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,817.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,946.68,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,786.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1611.56,,facility
1ST PSYC COLLAB CARE MGMT,99492,CPT,510,RC,,,,outpatient,,,106.16,10.62,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,97.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,97.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,97.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,203.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,97.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,99.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,97.23,448,,facility
ASSAY OF TOPIRAMATE,80201,CPT,301,RC,,,,outpatient,,,14.9,1.49,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,24.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.6,10.6,10.6,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.76,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.92,448,,facility
MRI JOINT UPR EXTREM W/O DYE,73221,CPT,610,RC,,,,outpatient,,,291.84,29.18,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,786,,,,,,,case rate,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,728,,,,,,,case rate,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1025,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1350,,,,,,,case rate,NTE Percentage + Reimbursement Rate 85.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,235.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,477.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,242.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,242.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2407,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,232.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,228.36,2407,,facility
ROTAVIRUS AG IA,87425,CPT,306,RC,,,,outpatient,,,14.98,1.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.9,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.98,448,,facility
ELECTRO-UROFLOWMETRY FIRST,51741,CPT,761,RC,,,,outpatient,,,373.83,37.38,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,206.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,206.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,212.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,206.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,431.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,219.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,206.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,219.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,210.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,206.65,448,,facility
EXC FACE-MM B9+MARG 2.1-3 CM,11443,CPT,761,RC,,,,outpatient,,,1930.94,193.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,1421.6,1421.6,1487.27,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1628.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3303.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1675.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,1442.85,1442.85,1442.85,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1675.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,1612.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3303.62,,facility
ALPHA-FETOPROTEIN L3,82107,CPT,301,RC,,,,outpatient,,,80.51,8.05,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,57.29,57.29,57.29,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,64.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,64.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,66.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,328.94,328.94,328.94,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,209.33,209.33,209.33,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,64.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,134.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,68.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,57.29,57.29,57.29,11,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,64.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,68.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,139.16,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,65.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,64.41,448,,facility
CONTROL NOSE/THROAT BLEEDING,42970,CPT,761,RC,,,,outpatient,,,290.91,29.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,226.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,226.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,233.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,226.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,473.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,240.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,226.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,240.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,231.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,226.68,1173,,facility
RBC ANTIBODY SCREEN,86850,CPT,302,RC,,,,outpatient,,,64.54,6.45,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,46.88,46,50.82,18,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,256.65,37.76,256.65,13,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,49.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,49.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,51.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,146.16,33.66,248.39,115,percent of total billed charges,,,33.6,,146.16,33.66,146.16,44,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,146.16,21.5,165.73,78,percent of total billed charges,,,34.6,,165.73,157.9,315.81,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,49.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,104.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,52.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,32,31.88,217.5,14,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,91.35,13.44,91.35,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,8.69,8.69,8.69,1 through 10,percent of total billed charges,,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,8.69,8.69,8.69,811,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,49.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,52.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.1,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,50.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.1,448,,facility
CLTX TMPRMAND DISLC 1ST/SBSQ,21480,CPT,761,RC,,,,outpatient,,,280.86,28.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,243.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,493.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,240.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,236.08,1173,,facility
I&D FOREARM&/WRIST BURSA,25031,CPT,450,RC,,,,outpatient,,,1914.16,191.42,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1585.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3216.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1631.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1631.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1569.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3216.38,,facility
EXC FACE-MM B9+MARG >4 CM,11446,CPT,761,RC,,,,outpatient,,,3384.19,338.42,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2779.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2779.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2863.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2779.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,5810.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2946.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,2548.7,2548.7,2548.7,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2779.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2946.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,2835.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,5810.16,,facility
ASSAY OF SERUM SODIUM,84295,CPT,301,RC,,,,outpatient,,,6.01,0.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.28,4.28,4.28,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,9.62,9.62,9.62,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,36.54,21.5,36.54,1 through 10,percent of total billed charges,,,33.6,,21.5,21.5,21.5,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,21.5,16.47,43.01,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,10.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.28,4.28,4.28,39,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.4,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,4.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,4.81,448,,facility
MR SPECTROSCOPY,76390,CPT,610,RC,,,,outpatient,,,108.23,10.82,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1025,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1350,,,,,,,case rate,NTE Percentage + Reimbursement Rate 85.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,85.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,174.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2407,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,84.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,83.29,2407,,facility
COLONOSCOPY W/INJECTION,44404,CPT,750,RC,,,,outpatient,,,1405.45,140.55,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1179.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,2393.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1213.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1213.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3821,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1168.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3821,,facility
MITOCHONDRIAL GENE,81440,CPT,310,RC,,,,outpatient,,,4155,415.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3324,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3324,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3423.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3324,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,6947.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3523.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3324,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3523.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5817,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,3390.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,6947.16,,facility
CLEAR OUTER EAR CANAL,69200,CPT,761,RC,,,,outpatient,,,152.14,15.21,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,131.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,266.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,134.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,134.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,129.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,127.33,448,,facility
TREATMENT OF ANKLE FRACTURE,27808,CPT,761,RC,,,,outpatient,,,280.86,28.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,243.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,493.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,240.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,236.08,1173,,facility
SIGMOIDOSCOPY W/SUBMUC INJ,45335,CPT,750,RC,,,,outpatient,,,1088.51,108.85,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,799.94,799.94,811.89,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,890.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,890.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,916.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,1679.25,1679.25,1679.25,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,1256.64,1256.64,1256.64,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,890.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1860.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,943.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,890.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,943.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2712,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,907.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,2712,,facility
CLTX HUMRL SHFT FX W/MNPJ,24505,CPT,761,RC,,,,outpatient,,,1914.16,191.42,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1585.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3216.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1631.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1631.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,1569.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3216.38,,facility
HBB GENE DUP/DEL VARIANTS,81363,CPT,310,RC,,,,outpatient,,,253,25.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,202.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,202.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,208.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,202.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,423.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,214.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,202.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,214.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,354.2,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,206.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,202.4,448,,facility
ASSAY CARBAMAZEPINE FREE,80157,CPT,301,RC,,,,outpatient,,,16.56,1.66,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.63,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.25,448,,facility
UNL THER/PROP/DIAG INJ/INF,96379,CPT,260,RC,,,,outpatient,,,56.58,5.66,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,44.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,44.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,46.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,44.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,93.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,47.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,44.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,47.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,427,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,45.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,44.82,448,,facility
ASSAY OF PHENYTOIN FREE,80186,CPT,301,RC,,,,outpatient,,,17.2,1.72,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,73.92,73.92,73.92,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,28.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.24,12.24,12.24,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.73,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.76,448,,facility
BIOPSY ROOF OF MOUTH,42100,CPT,761,RC,,,,outpatient,,,1816.31,181.63,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1484.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1484.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1529.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1484.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3103.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1574.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1484.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1574.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,1514.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3103.57,,facility
"INJ, BENDAMUSTINE HCL, 1MG",J9033,HCPCS,636,RC,,,,outpatient,,,6.71,0.67,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,2.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,6.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.87,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,3.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,2.96,448,,facility
ASSAY OF VITAMIN A,84590,CPT,301,RC,,,,outpatient,,,14.51,1.45,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.33,10.33,10.33,22,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,34.32,34.32,34.32,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,21.84,16.13,21.84,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,24.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,32.5,32.5,32.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.33,10.33,10.33,58,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.08,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,11.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.61,448,,facility
CYTOMEG DNA QUANT,87497,CPT,306,RC,,,,outpatient,,,53.55,5.36,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,38.11,38.11,38.11,50,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,44.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,385.19,152.4,747.39,1 through 10,percent of total billed charges,,,33.6,,339.7,339.7,533.81,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,385.19,342.73,385.19,14,percent of total billed charges,,,34.6,,385.19,366.99,385.19,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,89.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,45.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,212.31,212.31,212.31,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,38.11,38.11,38.11,203,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,45.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,92.54,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,43.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,42.84,448,,facility
URINALYSIS NONAUTO W/O SCOPE,81002,CPT,307,RC,,,,outpatient,,,4.35,0.44,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.1,3.1,3.1,63,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,7.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.1,3.1,3.1,277,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.09,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,3.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,3.48,448,,facility
INSERT EMERGENCY AIRWAY,31500,CPT,361,RC,,,,outpatient,,,290.91,29.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,226.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,226.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,233.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,226.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,473.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,240.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,226.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,240.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2440,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,231.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,226.68,2440,,facility
CT ORBIT/EAR/FOSSA W/DYE,70481,CPT,351,RC,,,,outpatient,,,218.83,21.88,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,156.2,154.84,167.87,12,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,403,,,,,,,case rate,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,371,,,,,,,case rate,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,875,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1050,,,,,,,case rate,NTE Percentage + Reimbursement Rate 85.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,172.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,4298.49,4298.49,4298.49,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,2529.41,2529.41,2529.41,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,350.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,177.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,105.19,105.19,110.2,12,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,177.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1522,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,171.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,167.87,1522,,facility
COOMBS TEST INDIRECT QUAL,86885,CPT,302,RC,,,,outpatient,,,203.43,20.34,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,167.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,340.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,172.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,172.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.37,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,166.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.37,448,,facility
L HRT ARTERY/VENTRICLE ANGIO,93458,CPT,480,RC,,,,outpatient,,,3880.91,388.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,2822.09,2822.09,5002.54,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,2004,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,2759,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,3102.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3102.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3195.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3102.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,6484.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3288.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,615.54,571.69,2919.38,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3102.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3288.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1463,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,3164.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,1463,6484.66,,facility
INTMD RPR FACE/MM 20.1-30.0,12056,CPT,361,RC,,,,outpatient,,,474.9,47.49,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,400.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,813.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,412.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,412.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2440,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,396.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,389.05,2440,,facility
SLEEP STUDY UNATT&RESP EFFT,95806,CPT,920,RC,,,,outpatient,,,186.04,18.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,137.28,137.28,137.28,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,206.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,206.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,212.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,206.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,431.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,219.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,42.86,42.86,42.86,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,206.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,219.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,422,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,210.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,206.65,448,,facility
ASPIRATE/INJ GANGLION CYST,20612,CPT,361,RC,,,,outpatient,,,352.75,35.28,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,293.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,293.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,302.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,293.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,613.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,311.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,293.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,311.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2440,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,299.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,293.77,2440,,facility
MRI NECK SPINE W/O DYE,72141,CPT,612,RC,,,,outpatient,,,291.84,29.18,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,212.09,212.09,212.09,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,786,,,,,,,case rate,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,728,,,,,,,case rate,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,5842.92,98.99,5842.92,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1025,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1350,,,,,,,case rate,NTE Percentage + Reimbursement Rate 85.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,235.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,4226.11,4226.11,4226.11,1 through 10,percent of total billed charges,,,33.6,,4570.28,4570.28,4570.28,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,2689.34,2689.34,2713.36,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,477.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,242.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,4002,4002,4002,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,105.48,105.48,105.48,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,242.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2407,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,232.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,228.36,2407,,facility
CORONARY ART/GRFT ANGIO S&I,93455,CPT,480,RC,,,,outpatient,,,3880.91,388.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,2822.09,2822.09,3059.51,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,2004,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,2759,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,3102.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3102.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3195.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3102.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,6484.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3288.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3102.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3288.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1463,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,3164.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,1463,6484.66,,facility
NFCT DS 22 TRGT SARS-COV-2,0202U,CPT,300,RC,,,,outpatient,,,520.98,52.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,408.03,408.03,408.03,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,477.44,367.36,477.44,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,416.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,416.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,429.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,232.06,232.06,232.06,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,250.66,218.69,270.8,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,416.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,871.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,441.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,373,373,373,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,416.78,408.03,416.78,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,416.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,441.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,729.37,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,425.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,416.78,871.07,,facility
TCAT INS 2CHMBR LDLS PM RA,0796T,CPT,480,RC,,,,outpatient,,,23206.69,2320.67,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1268,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1793,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 6500.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 10000.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,18434.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18434.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18987.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18434.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38528.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19540.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18434.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19540.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1463,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18803.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,38528.19,,facility
DRESS/DEBRID P-THICK BURN S,16020,CPT,420,RC,,,,outpatient,,,238.44,23.84,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,80,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,197.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,401.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,203.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,203.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,422,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,195.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,80,1173,,facility
DEVEL TST PHYS/QHP 1ST HR,96112,CPT,430,RC,,,,outpatient,,,186.04,18.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,80,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,123.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,123.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,126.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,123.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,257.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,130.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,75.63,75.63,75.63,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,123.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,130.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,422,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,125.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,80,448,,facility
PHLEBOTOMY,99195,CPT,940,RC,,,,outpatient,,,152.14,15.21,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,113.1,113.1,117.45,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,766.08,766.08,766.08,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,131.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,402.19,402.19,402.19,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,402.19,402.19,402.19,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,266.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,134.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,134.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,418,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,129.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,127.33,448,,facility
ASSAY RBC PROTOPORPHYRIN,84202,CPT,301,RC,,,,outpatient,,,17.94,1.79,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,29.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.99,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.35,448,,facility
ANALYZE SP INF PUMP W/REPROG,62368,CPT,361,RC,,,,outpatient,,,355.74,35.57,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,293.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,293.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,302.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,293.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,614.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,311.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,293.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,311.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2440,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,299.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,293.95,2440,,facility
CHEMODENERV ECCRINE GLANDS,64650,CPT,761,RC,,,,outpatient,,,352.75,35.28,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,293.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,293.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,302.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,293.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,613.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,311.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,293.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,311.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,299.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,293.77,1173,,facility
EPISIOTOMY OR VAGINAL REPAIR,59300,CPT,720,RC,,,,inpatient,,,3723.46,372.35,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Short Stay Lesser of + Days Threshold 1.00 + Stoploss First Dollar + Reimbursement Rate 57.00 + Basic Per Diem + Fixed Rate 5000.00 + Fixed Amount 157464.00,,,,0,other,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,Short Stay Lesser of + Days Threshold 1.00 + Stoploss First Dollar + Reimbursement Rate 72.00 + Basic Per Diem + Fixed Rate 10000.00 + Fixed Amount 56687.00,,,,0,other,NTE Percentage + Reimbursement Rate 85.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,47.3,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,facility
ASSAY OF AMIKACIN,80150,CPT,301,RC,,,,outpatient,,,18.85,1.89,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,31.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.57,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,15.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,15.08,448,,facility
CLTX SHO DSLC FX GR HMRL TBR,23665,CPT,761,RC,,,,outpatient,,,1914.16,191.42,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1585.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3216.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1631.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1631.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,1569.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3216.38,,facility
YERSINIA ANTIBODY,86793,CPT,302,RC,,,,outpatient,,,16.49,1.65,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.49,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.19,448,,facility
X-RAY XM COLON 2CNTRST STD,74280,CPT,320,RC,,,,outpatient,,,218.83,21.88,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,172.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,350.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,177.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,177.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,171.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,167.87,448,,facility
INSERT CATH PLEURA W/O IMAGE,32556,CPT,361,RC,,,,outpatient,,,2266.24,226.62,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,1836.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1836.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1891.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1836.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3838.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1946.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1836.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1946.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3821,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1873.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3838.31,,facility
US EXAM K TRANSPL W/DOPPLER,76776,CPT,402,RC,,,,outpatient,,,130.94,13.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,93.3,93.3,93.3,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,465,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,465,,facility
MR ANGIOGRAPHY HEAD W/O DYE,70544,CPT,610,RC,,,,outpatient,,,291.84,29.18,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1025,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1350,,,,,,,case rate,NTE Percentage + Reimbursement Rate 85.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,235.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,1709.23,1709.23,1709.23,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,477.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,242.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,242.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2407,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,232.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,228.36,2407,,facility
CHEMO HORMON ANTINEOPL SQ/IM,96402,CPT,331,RC,,,,outpatient,,,83.9,8.39,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,62.45,58.46,64.84,42,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,153.99,141.01,153.99,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,68.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,68.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,70.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,137.81,137.81,137.81,14,percent of total billed charges,,,33.6,,87.7,87.7,87.7,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,87.46,87.46,87.7,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,68.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,144.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,73.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,63.38,63.38,64.84,57,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,68.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,73.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1603,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,70.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,68.91,1603,,facility
CRYOPRECIPITATEREDUCEDPLASMA,P9044,HCPCS,390,RC,,,,outpatient,,,86.44,8.64,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,131.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,131.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,135.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,131.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,274.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,139.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,131.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,139.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,107,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,134.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,107,448,,facility
HRDTRY PERPH NEURPHY PANEL,81448,CPT,310,RC,,,,outpatient,,,731.13,73.11,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,584.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,584.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,602.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,584.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1222.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,619.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,584.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,619.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1263.68,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,596.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1263.68,,facility
DSTRJ MAL LES T/A/L >4.0 CM,17266,CPT,761,RC,,,,outpatient,,,474.9,47.49,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,400.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,813.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,412.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,412.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,396.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,389.05,1311,,facility
ANTITHROMBIN III ACTIVITY,85300,CPT,305,RC,,,,outpatient,,,14.81,1.48,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.54,10.54,10.54,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,38.54,24.53,38.54,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,24.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.54,10.54,10.54,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.6,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.85,448,,facility
CLTX STRNCLAV DISLC W/O MNPJ,23520,CPT,450,RC,,,,outpatient,,,1914.16,191.42,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1585.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3216.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1631.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1631.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1569.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3216.38,,facility
SERPINA1 GENE,81332,CPT,301,RC,,,,outpatient,,,54.56,5.46,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,43.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,43.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,44.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,43.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,91.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,46.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,43.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,46.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,94.31,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,44.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,43.65,448,,facility
X-RAY EXAM L-S SPINE BENDING,72114,CPT,320,RC,,,,outpatient,,,130.94,13.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,448,,facility
INTRO CATH DIALYSIS CIRCUIT,36901,CPT,361,RC,,,,outpatient,,,1907.41,190.74,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,1506.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1506.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1551.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1506.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3148.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1596.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1506.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1596.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3821,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1536.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3821,,facility
INTMD RPR S/TR/EXT 7.6-12.5,12034,CPT,761,RC,,,,outpatient,,,474.9,47.49,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,175.27,175.27,350.55,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,400.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,813.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,412.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,412.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,396.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,389.05,1311,,facility
CLOT FACTOR XI PTA,85270,CPT,305,RC,,,,outpatient,,,22.38,2.24,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.92,15.92,15.92,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,37.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.92,15.92,15.92,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.68,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.9,448,,facility
ANOSCOPY AND DILATION,46604,CPT,750,RC,,,,outpatient,,,1405.45,140.55,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1179.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,2393.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1213.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1213.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3821,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1168.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3821,,facility
VEEG EA 12-26HR CONT MNTR,95716,CPT,740,RC,,,,outpatient,,,1245.23,124.52,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,892.66,758.08,892.66,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,821.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,821.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,846.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,2145.79,1365.5,2145.79,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,821.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1717.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,871.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,1213.05,1213.05,1213.05,20,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,821.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,871.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1175,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,838.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1717.69,,facility
TREAT VAGINAL BLEEDING,57180,CPT,761,RC,,,,outpatient,,,237.33,23.73,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,193.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,193.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,199.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,193.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,404.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,205.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,193.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,205.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,197.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,193.49,448,,facility
DRAINAGE OF SALIVARY GLAND,42310,CPT,450,RC,,,,outpatient,,,655.29,65.53,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,516.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,516.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,531.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,516.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1078.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,547.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,516.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,547.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,526.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1173,,facility
BRCA1 GENE FULL DUP/DEL ALYS,81166,CPT,310,RC,,,,outpatient,,,376.69,37.67,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,301.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,301.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,310.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,301.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,629.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,319.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,301.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,319.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,527.36,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,307.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,301.35,629.82,,facility
"INJECTION, DARATUMUMAB 10 MG",J9145,HCPCS,636,RC,,,,outpatient,,,80.47,8.05,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,73.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,73.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,73.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,154.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,78.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,73.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,78.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,140.44,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,75.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,73.77,448,,facility
ALLG SPEC IGE MULTIALLG SCR,86005,CPT,302,RC,,,,outpatient,,,9.96,1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,7.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,16.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,7.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.22,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,8.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,7.97,448,,facility
VULVECTOMY SIMPLE PARTIAL,56620,CPT,761,RC,,,,outpatient,,,3723.46,372.35,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1445,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,2070,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3098.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3098.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3191.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3098.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,6475.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3284,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3098.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3284,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,3160.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,6475.05,,facility
REPAIR FOREARM TENDON/MUSCLE,25270,CPT,450,RC,,,,outpatient,,,3855.04,385.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1268,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1793,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3131.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3131.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3225.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3131.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,6544.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3319.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3131.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3319.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3194.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,6544.81,,facility
ASSAY OF IGE,82785,CPT,301,RC,,,,outpatient,,,20.58,2.06,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,14.64,14.64,14.64,32,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,44.88,28.56,175.87,1 through 10,percent of total billed charges,,,33.6,,124.52,124.52,124.52,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,28.56,28.56,28.56,1 through 10,percent of total billed charges,,,34.6,,32.29,32.29,117.35,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,34.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,14.64,14.64,14.64,106,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.56,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,16.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,16.46,448,,facility
NRAS GENE VARIANTS EXON 2&3,81311,CPT,310,RC,,,,outpatient,,,369.74,36.97,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,295.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,295.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,304.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,295.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,618.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,313.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,295.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,313.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,517.63,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,301.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,295.79,618.2,,facility
INTRACRANIAL COMPLETE STUDY,93886,CPT,921,RC,,,,outpatient,,,291.84,29.18,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,212.09,212.09,212.09,14,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,235.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,477.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,242.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,171.01,171.01,190.71,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,242.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1227,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,232.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,228.36,1227,,facility
CT ANGIO UPR EXTRM W/O&W/DYE,73206,CPT,350,RC,,,,outpatient,,,218.83,21.88,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,875,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1050,,,,,,,case rate,NTE Percentage + Reimbursement Rate 85.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,172.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,350.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,177.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,177.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1522,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,171.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,167.87,1522,,facility
PLMT NEPHROURETERAL CATHETER,50433,CPT,361,RC,,,,outpatient,,,4151.98,415.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,3373.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3373.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3474.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3373.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,7050.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3576.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3373.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3576.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9389,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,3441.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,9389,,facility
US EXAM PELVIC COMPLETE,76856,CPT,402,RC,,,,outpatient,,,130.94,13.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,93.3,92.3,93.3,33,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,1037.81,1037.81,1037.81,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,928.75,591.02,1004.39,1 through 10,percent of total billed charges,,,33.6,,591.02,591.02,591.02,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,591.02,591.02,591.02,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,879.5,879.5,879.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,58.51,58.51,61.07,49,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,465,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,465,,facility
CETUXIMAB INJECTION,J9055,HCPCS,636,RC,,,,outpatient,,,94.54,9.45,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,81.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,81.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,84.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,81.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,170.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,86.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,81.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,86.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,165.77,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,83.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,81.67,448,,facility
MRI CHEST W/O DYE,71550,CPT,610,RC,,,,outpatient,,,291.84,29.18,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,786,,,,,,,case rate,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,728,,,,,,,case rate,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1025,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1350,,,,,,,case rate,NTE Percentage + Reimbursement Rate 85.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,235.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,477.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,242.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,242.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2407,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,232.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,228.36,2407,,facility
URINE PREGNANCY TEST,81025,CPT,307,RC,,,,outpatient,,,10.76,1.08,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,7.66,7.66,7.66,156,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,68.48,17.28,107,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,48.04,35.95,61.1,142,percent of total billed charges,,,33.6,,35.95,35.95,61.1,24,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,35.95,27.8,35.95,71,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,17.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,9.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,53.5,41,53.5,18,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,22.47,22.47,22.47,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,7.66,7.66,7.66,1310,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,9.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.07,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,8.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,8.61,448,,facility
ASSAY OF SERUM POTASSIUM,84132,CPT,301,RC,,,,outpatient,,,5.95,0.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.23,4.23,4.23,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,9.52,9.52,9.52,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,39.4,23.18,39.4,1 through 10,percent of total billed charges,,,33.6,,23.18,23.18,23.18,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,23.18,19.49,46.37,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,9.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.23,4.23,4.23,39,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.94,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,4.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,4.76,448,,facility
ASSAY ALKALINE PHOSPHATASE,84075,CPT,301,RC,,,,outpatient,,,6.48,0.65,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.61,4.61,4.61,50,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,15.34,10.36,15.34,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,81,81,81,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,46.25,13.73,46.25,76,percent of total billed charges,,,33.6,,27.22,8.74,46.25,18,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,27.22,8.74,27.46,55,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,10.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,40.5,13,40.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,5.46,5.46,5.46,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.61,4.61,4.61,627,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.18,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.18,448,,facility
LEPTOSPIRA ANTIBODY,86720,CPT,302,RC,,,,outpatient,,,20.25,2.03,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,33.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.49,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,16.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,16.2,448,,facility
MURAMIDASE,85549,CPT,305,RC,,,,outpatient,,,23.44,2.34,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.68,16.68,16.68,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,35.38,35.38,35.38,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,39.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.68,16.68,16.68,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,40.51,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.75,448,,facility
HISTOPLASMA CAPSUL AG IA,87385,CPT,306,RC,,,,outpatient,,,16.56,1.66,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,126.26,126.26,126.26,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,225.98,225.98,225.98,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.79,11.79,13.25,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.9,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.25,448,,facility
US COMPL JOINT R-T W/IMG,76881,CPT,402,RC,,,,outpatient,,,130.94,13.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,93.3,93.3,93.3,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,8.61,8.61,8.61,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,465,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,465,,facility
ESOPHAGOSCOPY RIGID TRNSO,43180,CPT,750,RC,,,,outpatient,,,6974.64,697.46,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,5665.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5665.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5835.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5665.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,11841.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6005.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5665.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6005.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9389,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5778.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,11841.12,,facility
RMVL FB MUSC/TDN DEEP/COMP,20525,CPT,450,RC,,,,outpatient,,,3384.19,338.42,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1027,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1519,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2779.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2779.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2863.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2779.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,5810.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2946.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2779.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2946.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2835.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,5810.16,,facility
BLOOD SPLIT UNIT,P9011,HCPCS,390,RC,,,,outpatient,,,839,83.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,141.8,130.8,155.08,21,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,558.72,558.72,558.72,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,155.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,155.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,159.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,155.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,324.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,164.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,155.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,164.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,107,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,158.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,107,448,,facility
ASPIRATION AND/OR INJECTION OF FLUID FROM SMALL JOINT,20600,CPT,0761,RC,,,,outpatient,,,1081,108.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,293.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,293.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,302.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,293.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,613.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,311.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,293.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,311.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,299.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,293.77,1173,,facility
DETECT AGENT NOS DNA AMP,87798,CPT,306,RC,,,,outpatient,,,222,22.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,110.88,110.88,174.24,1 through 10,percent of total billed charges,,,33.6,,244.27,244.27,244.27,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,96.77,32.38,119.79,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,38.9,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
ASSAY OF PROTEIN SERUM,84155,CPT,301,RC,,,,outpatient,,,122,12.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.26,3.26,3.26,55,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,23.6,23.6,23.6,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,316,316,316,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,180.44,21.12,180.44,76,percent of total billed charges,,,33.6,,106.18,13.44,180.44,18,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,106.18,13.44,107.12,57,percent of total billed charges,,,34.6,,120.4,120.4,120.4,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,7.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,158,20,158,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,8.4,8.4,8.4,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.26,3.26,3.26,650,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.93,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,3.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,3.67,448,,facility
HIV-1 PROBE&REVERSE TRNSCRPJ,87535,CPT,306,RC,,,,outpatient,,,833,83.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,122.13,122.13,122.13,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,38.98,38.98,61.25,1 through 10,percent of total billed charges,,,33.6,,618.82,618.82,618.82,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,38.48,38.48,42.11,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
MEASUREMENT FOR STREP ANTIBODY (STREP THROAT),86060,CPT,0302,RC,,,,outpatient,,,110,11,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,40.99,40.99,40.99,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,7.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,15.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,7.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,6.49,6.49,6.49,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,7.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,7.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.77,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,7.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,7.3,448,,facility
KNEE-SHIN EXO MECH STANCE PH,L5716,HCPCS,274,RC,,,,outpatient,,,1528,152.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,66,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,61,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1038.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1038.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1069.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1038.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,2170.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1101.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1038.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1101.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,1059.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,1038.73,2170.95,,facility
FLUORESCENT ANTIBODY SCREEN,86255,CPT,302,RC,,,,outpatient,,,773,77.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.72,10.72,10.72,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,45.41,28.9,1068.67,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,28.9,28.9,28.9,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.72,10.72,10.72,19,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.04,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.05,448,,facility
DETECT AGENT NOS DNA QUANT,87799,CPT,306,RC,,,,outpatient,,,962,96.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,38.11,38.11,38.11,39,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,44.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,200.64,91.44,597.79,1 through 10,percent of total billed charges,,,33.6,,203.95,203.95,203.95,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,231.27,203.95,231.27,11,percent of total billed charges,,,34.6,,220.34,220.34,231.27,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,89.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,45.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,38.11,38.11,38.11,221,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,45.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,92.54,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,43.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,42.84,448,,facility
NFCT AGT GNTYP ALYS HIV1 REV,87901,CPT,306,RC,,,,outpatient,,,500,50,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,295,295,295,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,257.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,257.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,265.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,264,264,264,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,257.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,538.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,272.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,229,229,229,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,257.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,272.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,556.22,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,262.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,257.45,556.22,,facility
DETECT AGENT NOS DNA AMP,87798,CPT,306,RC,,,,outpatient,,,929,92.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,110.88,110.88,174.24,1 through 10,percent of total billed charges,,,33.6,,244.27,244.27,244.27,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,96.77,32.38,119.79,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,38.9,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
MEPERIDINE HYDROCHL /100 MG,J2175,HCPCS,636,RC,,,,outpatient,,,77,7.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,52.8,,1.85,1.85,13.4,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,1.86,1.86,1.86,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",448,448,,facility
BIOPSY OF EAR,69100,CPT,0761,RC,,,,outpatient,,,629,62.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,209.09,203.75,226.68,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,226.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,226.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,233.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,226.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,473.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,240.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,226.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,240.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,231.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,226.68,473.76,,facility
DETECT AGNT MULT DNA AMPLI,87801,CPT,306,RC,,,,outpatient,,,888,88.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,70.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,70.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,72.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,70.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,146.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,74.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,62.44,62.44,62.44,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,70.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,74.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,151.66,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,71.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,70.2,448,,facility
METHYLENEDIOXYAMPHETAMINES,80359,CPT,301,RC,,,,outpatient,,,431,43.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
REMOVAL OF INDWELLING TUBE IN LINING OF LUNG,32552,CPT,0361,RC,,,,outpatient,,,1880,188,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,600.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,600.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,618.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,697.87,697.87,697.87,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,600.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1254.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,636.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,600.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,636.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2712,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,612.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,2712,,facility
MITOCHONDRIAL ANTIBODY EACH,86381,CPT,302,RC,,,,outpatient,,,505,50.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,22.64,22.64,22.64,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,45.41,16.13,249.13,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,28.9,28.9,28.9,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,25.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,53.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,26.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,22.64,22.64,22.64,19,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,25.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,26.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,44.54,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,25.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,25.45,448,,facility
HSV DNA QUANT,87530,CPT,306,RC,,,,outpatient,,,532,53.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,44.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,89.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,45.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,45.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,92.54,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,43.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,42.84,448,,facility
INJECTION OF BILE DUCT FOR X-RAY THROUGH ALREADY EXISTING SKIN ACCESS USING IMAGING GUIDANCE WITH REVIEW BY RADIOLOGIST,47531,CPT,0361,RC,,,,outpatient,,,3679,367.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,3426.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3426.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3529.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,1825.19,1825.19,1825.19,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3426.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,7161.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3632.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3426.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3632.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10137,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,3495.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,10137,,facility
REPLACEMENT OF STOMACH-TO-SMALL BOWEL TUBE USING FLUOROSCOPIC GUIDANCE WITH CONTRAST,49452,CPT,0320,RC,,,,outpatient,,,4235,423.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,822.62,770.12,822.62,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,868.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,868.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,894.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,1572.48,1572.48,1572.48,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,868.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1814.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,920.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,834.91,834.91,837.91,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,868.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,920.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,885.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,443,1814.2,,facility
INITIAL NEW PATIENT PREVENTIVE MEDICINE EVALUATION (YOUNGER THAN 1 YEAR),99381,CPT,0770,RC,,,,outpatient,,,594,59.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,63.32,63.32,63.32,24,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
TRAINING FOR SELF-CARE OR HOME MANAGEMENT; EACH 15 MINUTES,97535,CPT,0430,RC,,,,outpatient,,,185,18.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,51.96,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,89.84,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,80,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,31.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,30.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,63.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,32.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,30.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,32.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,422,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,31.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,30.5,448,,facility
HOMOVANILLIC ACID (ORGANIC ACID) LEVEL,83150,CPT,0301,RC,,,,outpatient,,,63,6.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,23.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,46.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,23.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.93,19.93,19.93,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,23.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,41.81,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,22.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,22.41,448,,facility
DRUG TEST(S); DEFINITIVE; UTILIZING DRUG IDENTIFICATION METHODS ABLE TO IDENTIFY INDIVIDUAL DRUGS AND DISTINGUISH BETWEEN STRUCTURAL ISOMERS (BUT NOT NECESSARILY STEREOISOMERS); INCLUDING BUT NOT LIMITED TO GC/MS (ANY TYPE; SINGLE OR TANDEM) AND LC/MS (ANY TYPE; SINGLE OR TANDEM); EXCLUDING IMMUNOASSAYS (E.G.; IA; EIA; ELISA; EMIT; FPIA) AND ENZYMATIC METHODS (E.G.; ALCOHOL DEHYDROGENASE); PERFORMED WITHOUT METHOD OR DRUG-SPECIFIC CALIBRATION; WITHOUT MATRIX-MATCHED QUALITY CONTROL MATERIAL; OR WITHOUT USE OF STABLE ISOTOPE OR OTHER UNIVERSALLY RECOGNIZED INTERNAL STANDARD(S) FOR EACH DRUG; DRUG METABOLITE OR DRUG CLASS PER SPECIMEN; QUALITATIVE OR QUANTITATIVE; ALL SOURCES; INCLUDES SPECIMEN VALIDITY TESTING; PER DAY; ANY NUMBER OF DRUG CLASSES,G0659,HCPCS,0300,RC,,,,outpatient,,,301,30.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,221.44,184.32,221.44,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,62.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,62.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,171.87,96.77,197.57,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,116.26,102.04,116.26,15,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,62.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,129.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,65.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,144,144,173,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,72.66,72.66,72.66,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,62.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,65.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,125.7,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,63.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,62.14,448,,facility
VIT D 1 25-DIHYDROXY,82652,CPT,301,RC,,,,outpatient,,,271,27.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,34.25,34.25,34.25,16,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,30.68,30.68,30.68,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,39.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,41.71,17.47,46.99,1 through 10,percent of total billed charges,,,33.6,,17.47,17.47,29.9,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,26.78,26.54,26.78,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,38.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,80.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,40.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,39.5,39.5,39.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,34.25,34.25,34.25,35,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,38.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,40.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.18,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,39.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,38.5,448,,facility
UNLISTED MOLECULAR PATHOLOGY,81479,CPT,310,RC,,,,outpatient,,,8520,852,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,561.56,561.56,561.56,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,32.5,32.5,3071.5,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
DTAP-IPV/HIB VACCINE IM,90698,CPT,636,RC,,,,outpatient,,,230,23,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",448,448,,facility
COLLAGEN CROSSLINKS,82523,CPT,301,RC,,,,outpatient,,,207,20.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,39.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.62,16.62,16.62,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,40.37,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.68,448,,facility
RUSSELL VIPER VENOM DILUTED,85613,CPT,305,RC,,,,outpatient,,,82,8.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,8.52,8.52,8.52,20,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,82.37,20.06,82.37,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,52.42,52.42,52.42,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,9.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,20.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,8.52,8.52,8.52,34,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,9.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.7,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,9.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,9.58,448,,facility
INSERTION OF NEEDLE INTO VEIN (YOUNGER THAN 3 YEARS),36406,CPT,0761,RC,,,,outpatient,,,63,6.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,7.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,15.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,7.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,7.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,7.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,22.3,7.8,40.75,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,7.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,7.47,448,,facility
IMMUNOASSAY QUANT NOS NONAB,83520,CPT,301,RC,,,,outpatient,,,640,64,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,36,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,66.08,66.08,66.08,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,41.18,24.82,318.38,1 through 10,percent of total billed charges,,,33.6,,37.63,37.63,96.43,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,33.6,23.18,176.4,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,36.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,87,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.22,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.27,448,,facility
EXOME SEQUENCE ANALYSIS,81416,CPT,310,RC,,,,outpatient,,,3661,366.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12000,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12000,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12360,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12000,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25080,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12720,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12000,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12720,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21000,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12240,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,25080,,facility
FLUORESCENT ANTIBODY SCREEN,86255,CPT,302,RC,,,,outpatient,,,1377,137.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.72,10.72,10.72,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,45.41,28.9,1068.67,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,28.9,28.9,28.9,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.72,10.72,10.72,19,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.04,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.05,448,,facility
X-RAY OF LOWER AND SACRAL SPINE; MINIMUM OF 4 VIEWS,72110,CPT,0320,RC,,,,outpatient,,,1379,137.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,882.56,882.56,882.56,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,728.11,728.11,728.11,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,467.48,467.48,467.48,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,448,,facility
BACTERIUM ANTIBODY,86609,CPT,302,RC,,,,outpatient,,,65,6.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,26.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.88,448,,facility
SO/HL 51/>GSAP DNA/DNA&RNA,81455,CPT,310,RC,,,,outpatient,,,9194,919.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2919.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2919.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3007.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2919.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,6101.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3094.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2919.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3094.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5109.3,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,2977.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,6101.96,,facility
HEPARIN NEUTRALIZATION,85525,CPT,305,RC,,,,outpatient,,,500,50,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,24.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.59,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.84,448,,facility
TOBRAMYCIN (ANTIBIOTIC) LEVEL,80200,CPT,0301,RC,,,,outpatient,,,157,15.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,33.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,34.84,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,16.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,16.13,448,,facility
ASSAY OF LRH HORMONE,83727,CPT,301,RC,,,,outpatient,,,400,40,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,35.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,37.14,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.19,448,,facility
ASSAY OF METANEPHRINES,83835,CPT,301,RC,,,,outpatient,,,169,16.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.07,15.07,15.07,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,32.45,32.45,32.45,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,35.28,35.28,35.28,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,35.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.07,15.07,15.07,11,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.61,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,16.94,448,,facility
PT EVAL LOW COMPLEX 20 MIN,97161,CPT,424,RC,,,,outpatient,,,640,64,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,51.96,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,89.84,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,80,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,92.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,92.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,95.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,92.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,194.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,98.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,92.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,98.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,422,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,94.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,51.96,448,,facility
PROGRAMMING OF SINGLE; DUAL OR MULTIPLE LEAD IMPLANTABLE DEFIBRILLATOR SYSTEM BEFORE OR AFTER SURGERY,93287,CPT,0480,RC,,,,outpatient,,,173,17.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,20.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,20.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,43.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,20.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1463,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,21.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,20.88,1463,,facility
BIOPSY OF EXTENSIVE AREA OF VAGINAL MUCOUS MEMBRANE,57105,CPT,0761,RC,,,,outpatient,,,7782,778.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3098.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3098.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3191.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3098.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,6475.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3284,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3098.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3284,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,3160.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,6475.05,,facility
DRUG SCREENING COCAINE,80353,CPT,301,RC,,,,outpatient,,,824,82.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
MRI UPPER EXTREMITY W/O DYE,73218,CPT,610,RC,,,,outpatient,,,5626,562.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,786,,,,,,,case rate,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,728,,,,,,,case rate,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1025,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1350,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,235.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,477.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,242.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,242.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2407,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,232.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,228.36,2407,,facility
CHLAMYDIA IGM ANTIBODY,86632,CPT,302,RC,,,,outpatient,,,27,2.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,26.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.41,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.68,448,,facility
SPECIAL STAINS GROUP 1,88312,CPT,310,RC,,,,outpatient,,,280,28,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,50.82,50.82,50.82,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,188.16,188.16,1128.96,16,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,173.46,173.46,173.46,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,49.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,49.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,51.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,197.57,197.57,592.7,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,49.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,104.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,52.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,69.57,69.57,72.46,29,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,49.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,52.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,78.23,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,50.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,49.87,448,,facility
SC STD AGAR DILUTION PER AGT,87181,CPT,306,RC,,,,outpatient,,,164,16.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,9.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.26,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,4.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,4.75,448,,facility
RED BLOOD CELL ANTIBODY DETECTION TEST; DIRECT,86880,CPT,0302,RC,,,,outpatient,,,172,17.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,52.12,52.12,52.12,13,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,56.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,56.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,58.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,272.45,57.02,294.64,27,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,57.79,57.79,57.79,1 through 10,percent of total billed charges,,,34.6,,187.31,187.31,187.31,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,56.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,118,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,59.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.79,4.79,4.79,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,56.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,59.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.64,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,57.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.64,448,,facility
IMAGING FOR EVALUATION OF SWALLOWING FUNCTION,74230,CPT,0320,RC,,,,outpatient,,,2013,201.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,1288.32,1288.32,1288.32,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,172.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,1062.86,1062.86,1062.86,1 through 10,percent of total billed charges,,,33.6,,682.41,676.37,1062.86,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,676.37,676.37,676.37,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,350.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,177.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,1006.5,1006.5,1006.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,78.23,78.23,83.01,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,177.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,171.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,167.87,448,,facility
FLUORESCENT ANTIBODY SCREEN,86255,CPT,302,RC,,,,outpatient,,,189,18.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.72,10.72,10.72,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,45.41,28.9,1068.67,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,28.9,28.9,28.9,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.72,10.72,10.72,19,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.04,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.05,448,,facility
ASSAY OF CRYOGLOBULIN,82595,CPT,301,RC,,,,outpatient,,,30,3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.75,5.75,5.75,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,38.54,38.54,38.54,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,13.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.75,5.75,5.75,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.97,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,6.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,6.47,448,,facility
ASSAY OF LACTIC ACID,83605,CPT,301,RC,,,,outpatient,,,227,22.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.29,10.29,10.29,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,129.62,76.27,637.81,57,percent of total billed charges,,,33.6,,275.32,76.27,451.58,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,375.31,76.27,375.31,34,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,24.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,558.5,113.5,1117,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.29,10.29,10.29,439,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,23.08,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,11.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.57,448,,facility
COAGULATION TIME ACTIVATED,85347,CPT,305,RC,,,,outpatient,,,32,3.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,57.12,38.17,224.4,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,8.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.81,3.81,3.81,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.21,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,4.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,4.28,448,,facility
ANTITHROMBIN III ANTIGEN,85301,CPT,305,RC,,,,outpatient,,,77,7.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9.62,9.62,9.62,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,95.09,95.09,95.09,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,22.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9.62,9.62,9.62,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,23.36,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,11.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,10.81,448,,facility
ASSAY ALKALINE PHOSPHATASES,84080,CPT,301,RC,,,,outpatient,,,37,3.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.15,13.15,13.15,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,12.43,12.43,12.43,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,12.43,12.43,12.54,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,30.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.15,13.15,13.15,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,31.94,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,15.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.78,448,,facility
VINORELBINE TARTRATE INJ,J9390,HCPCS,636,RC,,,,outpatient,,,105,10.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",448,448,,facility
REMOVAL OF IMPACTED EAR WAX,69210,CPT,0450,RC,,,,outpatient,,,783,78.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,56.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,56.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,58.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,56.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,118,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,59.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,56.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,59.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,57.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,56.46,1173,,facility
GOSERELIN ACETATE IMPLANT,J9202,HCPCS,636,RC,,,,outpatient,,,2703,270.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,1594.77,1594.77,1594.77,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,1427.18,1427.18,1427.18,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1511.58,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,1511.58,,facility
CMV ANTIBODY,86644,CPT,302,RC,,,,outpatient,,,47,4.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.8,12.8,12.8,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,30.08,30.08,85.12,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,70.22,44.69,76.56,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,49.24,48.72,49.24,1 through 10,percent of total billed charges,,,34.6,,48.28,17.91,50.67,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,30.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.8,12.8,12.8,11,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,31.1,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.39,448,,facility
MOPATH PROCEDURE LEVEL 2,81401,CPT,310,RC,,,,outpatient,,,902,90.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,121.86,121.86,121.86,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,137,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,137,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,141.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,137,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,286.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,145.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,137,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,145.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,239.75,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,139.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,137,448,,facility
BABESIA MICROTI AMP PRB,87469,CPT,306,RC,,,,outpatient,,,879,87.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,61.41,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
VIRUS ISOLATION,87255,CPT,0306,RC,,,,outpatient,,,101,10.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,33.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,33.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,34.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,33.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,70.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,33.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,73.17,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,34.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,33.86,448,,facility
MOPATH PROCEDURE LEVEL 5,81404,CPT,310,RC,,,,outpatient,,,710,71,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,274.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,274.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,283.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,274.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,574.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,291.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,274.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,291.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,480.95,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,280.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,274.83,574.39,,facility
MRI SCAN OF PELVIS WITHOUT CONTRAST,72195,CPT,0610,RC,,,,outpatient,,,5576,557.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,786,,,,,,,case rate,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,728,,,,,,,case rate,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1025,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1350,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,235.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,2944.13,1873.54,2944.13,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,1873.54,1873.54,1873.54,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,477.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,242.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,242.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2407,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,232.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,228.36,2407,,facility
PROGRAMMING OF MULTIPLE LEAD PACEMAKER SYSTEM,93281,CPT,0480,RC,,,,outpatient,,,221,22.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,35.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,74.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,33.98,33.98,33.98,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1463,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,36.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.71,1463,,facility
ASSAY OF 17-HYDROXYPREGNENO,84143,CPT,301,RC,,,,outpatient,,,28.51,2.85,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,20.29,20.29,20.29,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,23.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,47.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,24.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,20.29,20.29,20.29,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,24.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,49.28,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,23.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,22.81,448,,facility
EXC TR-EXT MAL+MARG 1.1-2 CM,11602,CPT,761,RC,,,,outpatient,,,474.9,47.49,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,350.55,350.55,366.07,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,400.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,813.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,412.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,412.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,396.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,389.05,1173,,facility
LOWER EXTREMITY STUDY,93925,CPT,921,RC,,,,outpatient,,,291.84,29.18,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,235.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,477.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,242.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,242.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1227,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,232.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,228.36,1227,,facility
TP53 GENE TRGT SEQUENCE ALYS,81352,CPT,310,RC,,,,outpatient,,,411.89,41.19,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,329.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,329.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,339.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,1529.23,1529.23,1529.23,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,329.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,688.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,349.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,329.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,349.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,576.64,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,336.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,329.51,688.68,,facility
TRANSPLT ALLO LYMPHOCYTES,38242,CPT,761,RC,,,,outpatient,,,1827.36,182.74,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,3262.72,3262.72,3262.72,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1490.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1490.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1535.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1490.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3115.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1579.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1490.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1579.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,1520.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3115.25,,facility
PMS2 KNOWN FAMILIAL VARIANTS,81318,CPT,310,RC,,,,outpatient,,,413.75,41.38,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,331,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,331,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,340.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,331,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,691.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,350.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,331,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,350.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,579.25,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,337.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,331,691.79,,facility
LARYNGOSCOPY TELESCOPIC,31579,CPT,440,RC,,,,outpatient,,,486.31,48.63,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,80,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,374.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,374.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,385.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,374.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,782.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,396.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,374.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,396.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,449,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,381.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,80,1311,,facility
ASSAY OF CARNITINE,82379,CPT,301,RC,,,,outpatient,,,21.09,2.11,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.01,15.01,15.01,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,191.14,191.14,191.14,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,35.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.01,15.01,15.01,15,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.45,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,16.87,448,,facility
EGD BIOPSY SINGLE/MULTIPLE,43239,CPT,750,RC,,,,outpatient,,,1079.61,107.96,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,800.68,400.34,822.62,144,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,458,458,916,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,868.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,868.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,894.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,1988.16,1487.81,1988.17,15,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,1487.81,1350.24,1487.81,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,868.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1814.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,920.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,2214,2214,2214,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,834.91,408.37,834.91,165,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,868.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,920.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3821,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,885.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3821,,facility
BX BREAST PERCUT W/O IMAGE,19100,CPT,761,RC,,,,outpatient,,,1930.94,193.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1628.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3303.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1675.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1675.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,1612.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3303.62,,facility
PRGRMG EVAL IMPLANTABLE DFB,93284,CPT,480,RC,,,,outpatient,,,44.91,4.49,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,173.44,173.44,173.44,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,35.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,74.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,32.47,32.47,38.02,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1463,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,36.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.71,1463,,facility
PANITUMUMAB INJECTION,J9303,HCPCS,636,RC,,,,outpatient,,,198.36,19.84,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,182.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,182.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,187.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,182.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,380.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,193.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,182.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,193.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,356.28,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,185.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,182.19,448,,facility
FETAL FLUID DRAINAGE W/US,59074,CPT,761,RC,,,,outpatient,,,382.08,38.21,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,291.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,291.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,300.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,291.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,609.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,309.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,291.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,309.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,297.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,291.64,1173,,facility
DSTR CUT VSC PRLF LES<10SQCM,17106,CPT,761,RC,,,,outpatient,,,474.9,47.49,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,400.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,813.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,412.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,412.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,396.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,389.05,1173,,facility
REMOVE TUNNELED IP CATH,49422,CPT,361,RC,,,,outpatient,,,3796.26,379.63,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,3021.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3021.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3112.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3021.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,6315.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3203.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3021.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3203.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10137,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,3082.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,10137,,facility
ASSAY OF PSA FREE,84154,CPT,301,RC,,,,outpatient,,,22.99,2.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.36,16.36,16.36,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,32.74,32.74,42.77,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,5.71,5.71,5.71,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.36,16.36,16.36,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,39.74,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.39,448,,facility
RMVL FB UPPER ARM/ELBW DEEP,24201,CPT,450,RC,,,,outpatient,,,3384.19,338.42,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2779.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2779.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2863.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2779.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,5810.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2946.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2779.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2946.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2835.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,5810.16,,facility
I&D PERIANAL ABSCESS SUPFC,46050,CPT,761,RC,,,,outpatient,,,1088.51,108.85,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,890.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,890.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,916.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,890.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1860.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,943.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,890.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,943.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,907.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1860.16,,facility
LAPAROSCOPY BIOPSY,49321,CPT,360,RC,,,,outpatient,,,6871.99,687.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1268,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1793,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,5785.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5785.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5959.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5785.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,12092.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6133.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5444.03,5444.03,5444.03,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5785.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6133.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10550,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5901.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,12092.57,,facility
M/PHMTRC ALYS ISHQUANT/SEMIQ,88377,CPT,312,RC,,,,outpatient,,,203.43,20.34,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,150.35,150.35,163,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,464,464,464,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,167.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,443.86,443.86,697.49,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,340.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,172.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,277.91,263.3,277.91,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,172.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,226.07,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,166.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,163.06,448,,facility
NFCT AGT GNTYP ALYS HEP B,87912,CPT,306,RC,,,,outpatient,,,321.81,32.18,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,257.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,257.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,265.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,257.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,538.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,272.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,257.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,272.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,556.22,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,262.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,257.45,556.22,,facility
LYMPH CHORIOMENINGITIS AB,86727,CPT,302,RC,,,,outpatient,,,16.09,1.61,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,26.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.81,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.87,448,,facility
X-RAY EXAM NECK SPINE 6/>VWS,72052,CPT,320,RC,,,,outpatient,,,130.94,13.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,681.6,681.6,681.6,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,448,,facility
IADNA-DNA/RNA PROBE TQ 6-11,87506,CPT,306,RC,,,,outpatient,,,328.74,32.87,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,262.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,262.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,270.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,262.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,549.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,278.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,262.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,278.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,461.11,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,268.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,262.99,549.65,,facility
CYSTO W/URETER STRICTURE TX,52341,CPT,761,RC,,,,outpatient,,,4151.98,415.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1027,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1519,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3373.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3373.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3474.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3373.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,7050.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3576.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3373.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3576.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,3441.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,7050.84,,facility
CLTX SHO DISLC NECK FX MNPJ,23675,CPT,450,RC,,,,outpatient,,,1914.16,191.42,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1585.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3216.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1631.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1631.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1569.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3216.38,,facility
UNLISTED CV SVC/PROCEDURE,93799,CPT,481,RC,,,,outpatient,,,186.04,18.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,123.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,123.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,126.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,123.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,257.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,130.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,123.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,130.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2440,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,125.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,123.14,2440,,facility
OSTEOPATH MANJ 1-2 REGIONS,98925,CPT,530,RC,,,,outpatient,,,30.9,3.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,20.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,43.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,21.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,20.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,21.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,21.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,20.67,448,,facility
TOTAL CORTISOL,82533,CPT,301,RC,,,,outpatient,,,20.38,2.04,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,14.5,14.5,14.5,28,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,68.44,68.44,68.44,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,203.28,61.25,203.28,34,percent of total billed charges,,,33.6,,203.28,129.36,203.28,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,129.36,29.57,130.52,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,34.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,192.5,58,192.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,14.5,14.5,14.5,104,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.21,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,16.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,16.3,448,,facility
SMALL BOWEL ENDOSCOPY,44382,CPT,750,RC,,,,outpatient,,,1079.61,107.96,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,868.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,868.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,894.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,868.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1814.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,920.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,868.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,920.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3821,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,885.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3821,,facility
EXC FACE-MM B9+MARG 0.6-1 CM,11441,CPT,761,RC,,,,outpatient,,,837.95,83.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,617.33,617.33,626.56,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,677.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,677.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,698.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,677.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1416.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,718.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,626.56,313.28,637.68,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,677.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,718.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,691.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1416.43,,facility
SKIN FUNGI CULTURE,87101,CPT,306,RC,,,,outpatient,,,9.64,0.96,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,6.86,6.86,6.86,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,43.66,43.66,43.66,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,206.98,206.98,206.98,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,7.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,16.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,6.86,6.86,6.86,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,7.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.64,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,7.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,7.71,448,,facility
HBB FULL GENE SEQUENCE,81364,CPT,310,RC,,,,outpatient,,,405.73,40.57,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,324.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,324.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,334.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,324.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,678.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,344.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,324.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,344.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,568.02,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,331.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,324.58,678.37,,facility
FMR1 GEN ALY DETC ABNL ALLEL,81243,CPT,310,RC,,,,outpatient,,,71.3,7.13,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,57.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,57.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,58.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,57.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,119.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,60.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,50.74,50.74,50.74,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,57.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,60.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,99.82,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,58.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,57.04,448,,facility
KIT GENE ANALYS D816 VARIANT,81273,CPT,310,RC,,,,outpatient,,,156.09,15.61,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,111.07,111.07,111.07,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,124.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,124.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,128.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,124.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,260.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,132.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,111.07,111.07,111.07,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,124.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,132.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,218.52,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,127.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,124.87,448,,facility
UROGRAPHY IV +-KUB TOMOG,74400,CPT,320,RC,,,,outpatient,,,218.83,21.88,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,172.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,350.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,177.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,177.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,171.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,167.87,448,,facility
CAR ION CHNNLPATH INC 10 GNS,81413,CPT,310,RC,,,,outpatient,,,731.13,73.11,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,584.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,584.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,602.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,584.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1222.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,619.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,584.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,619.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1263.68,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,596.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1263.68,,facility
CORONARY ARTERY ANGIO S&I,93454,CPT,480,RC,,,,outpatient,,,3880.91,388.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2004,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,2759,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,3102.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3102.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3195.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,8276.46,8276.46,8276.46,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3102.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,6484.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3288.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3102.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3288.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1463,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,3164.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,1463,6484.66,,facility
INTMD RPR S/A/T/EXT 2.5 CM/<,12031,CPT,761,RC,,,,outpatient,,,474.9,47.49,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,175.27,175.27,183.04,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,400.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,813.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,412.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,177.9,177.9,177.9,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,412.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,396.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,389.05,1173,,facility
ASPERGILLUS AG IA,87305,CPT,306,RC,,,,outpatient,,,14.98,1.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.66,10.66,10.66,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,82.9,82.9,82.9,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,86.68,86.68,86.68,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.66,10.66,10.66,16,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.9,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.98,448,,facility
RBC OSMOTIC FRAGILITY,85557,CPT,305,RC,,,,outpatient,,,16.7,1.67,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.86,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.36,448,,facility
X-RAY EXAM HIP UNI 1 VIEW,73501,CPT,320,RC,,,,outpatient,,,108.23,10.82,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,85.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,174.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.68,19.68,19.68,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,84.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,83.29,448,,facility
INJ TRUXIMA 10 MG,Q5115,HCPCS,636,RC,,,,outpatient,,,42.13,4.21,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,9004.8,9004.8,9408,137,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,34.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,34.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,34.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,72.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,36.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,34.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,36.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,68.43,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,34.56,448,,facility
PROTHROMBIN TEST,85611,CPT,305,RC,,,,outpatient,,,4.93,0.49,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,8.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.52,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,4.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,3.94,448,,facility
BRENTUXIMAB VEDOTIN INJ,J9042,HCPCS,636,RC,,,,outpatient,,,299.5,29.95,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,122661.18,98415.85,127444.99,499,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,279.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,279.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,287.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,279.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,583.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,295.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,279.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,295.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,535.2,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,284.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,279.21,583.55,,facility
CLTX PRX HMRL FX MNPJ+-TRACT,23605,CPT,761,RC,,,,outpatient,,,1914.16,191.42,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1585.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3216.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1631.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1631.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,1569.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3216.38,,facility
CT ABDOMEN W/O CONTRAST,74150,CPT,352,RC,,,,outpatient,,,130.94,13.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,403,,,,,,,case rate,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,371,,,,,,,case rate,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,411,411,411,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,875,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1050,,,,,,,case rate,NTE Percentage + Reimbursement Rate 85.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,2667.46,2667.46,2667.46,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1522,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,1522,,facility
EXC TR-EXT B9+MARG 0.6-1 CM,11401,CPT,761,RC,,,,outpatient,,,474.9,47.49,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,328.18,328.18,350.55,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,400.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,813.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,412.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,355.79,355.79,355.79,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,412.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,396.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,389.05,1173,,facility
ANTISTREPTOLYSIN O TITER,86060,CPT,302,RC,,,,outpatient,,,9.13,0.91,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,40.99,40.99,40.99,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,7.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,15.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,7.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,6.49,6.49,6.49,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,7.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,7.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.77,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,7.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,7.3,448,,facility
MECHANICAL CHEST WALL OSCILL,94669,CPT,410,RC,,,,inpatient,,,254.03,25.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Short Stay Lesser of + Days Threshold 1.00 + Stoploss First Dollar + Reimbursement Rate 57.00 + Basic Per Diem + Fixed Rate 5000.00 + Fixed Amount 157464.00,,,,0,other,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,Short Stay Lesser of + Days Threshold 1.00 + Stoploss First Dollar + Reimbursement Rate 72.00 + Basic Per Diem + Fixed Rate 10000.00 + Fixed Amount 56687.00,,,,0,other,NTE Percentage + Reimbursement Rate 85.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,47.3,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,facility
RADIATION PHYSICS CONSULT,77336,CPT,333,RC,,,,outpatient,,,161.6,16.16,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,116.49,116.49,121.04,75,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,904.32,833.67,904.32,20,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,833.67,833.67,833.67,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,128.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,128.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,132.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,474.77,474.77,746.06,22,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,474.77,474.77,474.77,14,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,128.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,268.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,136.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,706.5,706.5,706.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,118.23,118.23,121.04,81,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,128.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,136.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,48815,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,131.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,128.64,48815,,facility
EGD VARICES LIGATION,43244,CPT,750,RC,,,,outpatient,,,2266.24,226.62,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,1664.42,1664.42,1664.42,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,1836.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1836.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1891.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1836.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3838.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1946.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,1689.3,1689.3,1727.99,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1836.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1946.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3821,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1873.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3838.31,,facility
ASSAY OF ETHOSUXIMIDE,80168,CPT,301,RC,,,,outpatient,,,20.43,2.04,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,34.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,14.53,14.53,14.53,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.3,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,16.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,16.34,448,,facility
X-RAY EXAM HIP UNI 4/> VIEWS,73503,CPT,320,RC,,,,outpatient,,,130.94,13.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,448,,facility
ASSAY OF QUININE,84228,CPT,301,RC,,,,outpatient,,,14.54,1.45,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,24.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.13,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,11.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.63,448,,facility
R&L HRT CATH CHD ABNL NT CNJ,93597,CPT,480,RC,,,,outpatient,,,3880.91,388.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,2822.09,2822.09,3059.51,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,2004,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,2759,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,3102.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3102.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3195.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3102.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,6484.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3288.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3102.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3288.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1463,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,3164.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,6484.66,,facility
RADEX OSSEOUS SURVEY COMPL,77075,CPT,329,RC,,,,outpatient,,,130.94,13.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,94.14,94.14,94.7,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,448,,facility
ASSAY OF ESTRIOL,82677,CPT,301,RC,,,,outpatient,,,30.23,3.02,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,21.51,21.51,21.51,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,7.73,7.73,7.73,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,24.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,50.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,25.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,21.51,21.51,51.51,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,24.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,25.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,52.24,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,24.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,24.18,448,,facility
R&L HRT ART/VENTRICLE ANGIO,93460,CPT,480,RC,,,,outpatient,,,3880.91,388.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2004,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,2759,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,3102.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3102.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3195.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,8797.49,8797.49,8797.49,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3102.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,6484.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3288.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3102.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3288.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1463,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,3164.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,1463,6484.66,,facility
TREAT HIP DISLOCATION,27265,CPT,761,RC,,,,outpatient,,,280.86,28.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,243.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,493.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,240.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,236.08,1173,,facility
REMOVAL OF FOOT FOREIGN BODY,28190,CPT,761,RC,,,,outpatient,,,837.95,83.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,677.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,677.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,698.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,677.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1416.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,718.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,677.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,718.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,691.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1416.43,,facility
AORTIC DYSFUNCTION/DILATION,81411,CPT,301,RC,,,,outpatient,,,1687.74,168.77,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1350.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1350.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1390.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1350.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,2821.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1431.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1350.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1431.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2362.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1377.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,2821.9,,facility
TREAT FOOT DISLOCATION,28605,CPT,450,RC,,,,outpatient,,,280.86,28.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,243.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,493.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,240.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,236.08,1173,,facility
CLOT FACTOR WGHT KININOGEN,85293,CPT,305,RC,,,,outpatient,,,23.66,2.37,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,39.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,20.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,20.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,40.9,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.93,448,,facility
CONIZATION OF CERVIX,57522,CPT,761,RC,,,,outpatient,,,3723.46,372.35,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3098.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3098.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3191.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3098.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,6475.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3284,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3098.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3284,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,3160.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,6475.05,,facility
BLINK REFLEX TEST,95933,CPT,920,RC,,,,outpatient,,,72.85,7.29,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,56.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,56.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,58.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,56.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,118,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,59.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,56.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,59.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,422,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,57.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,56.46,448,,facility
REPAIR TONGUE LACERATION,41252,CPT,761,RC,,,,outpatient,,,290.91,29.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,226.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,226.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,233.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,226.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,473.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,240.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,226.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,240.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,231.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,226.68,1311,,facility
APHERESIS RBC,36512,CPT,940,RC,,,,outpatient,,,1827.36,182.74,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1490.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1490.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1535.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1490.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3115.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1579.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,4431.42,4431.42,4431.42,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1490.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1579.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,418,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1520.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,418,3115.25,,facility
REMOVE BRAIN CAVITY FLUID,61020,CPT,761,RC,,,,outpatient,,,1085.56,108.56,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,846.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,846.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,871.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,846.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1769.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,897.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,846.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,897.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,863.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1769.16,,facility
CABAZITAXEL INJECTION,J9043,HCPCS,636,RC,,,,outpatient,,,269.38,26.94,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,233.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,233.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,240.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,233.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,488.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,247.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,233.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,247.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,481.79,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,238.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,233.73,488.5,,facility
APPL SHORT LEG CAST WALKING,29425,CPT,761,RC,,,,outpatient,,,319.85,31.99,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,267.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,267.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,275.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,267.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,559.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,283.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,267.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,283.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,273.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,267.68,559.45,,facility
SIGMOIDOSCOPY W/ABLATION,45346,CPT,750,RC,,,,outpatient,,,1405.45,140.55,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1179.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,2393.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1213.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1213.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3821,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1168.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3821,,facility
TREPONEMA PALLIDUM,86780,CPT,302,RC,,,,outpatient,,,16.55,1.66,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.78,11.78,11.78,612,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,10.62,10.62,50.15,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,9.5,6.05,48.53,46,percent of total billed charges,,,33.6,,6.05,6.05,44.88,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,6.05,6.05,28.56,66,percent of total billed charges,,,34.6,,73.69,20.19,77.34,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,9,9,42.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,17.85,17.85,17.85,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,11.78,11.78,11.78,1 through 10,percent of total billed charges,,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.78,11.78,11.78,550,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.6,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.24,448,,facility
FNA BX W/O IMG GDN 1ST LES,10021,CPT,761,RC,,,,outpatient,,,474.9,47.49,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,350.55,350.55,350.55,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,400.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,813.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,412.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,335.79,335.79,335.79,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,412.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,396.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,389.05,1173,,facility
HLTH BHV ASSMT/REASSESSMENT,96156,CPT,914,RC,,,,outpatient,,,106.16,10.62,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,89.68,81.16,97.23,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,97.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,97.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,97.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,203.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,97.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,99.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,97.23,448,,professional
EXC FACE-MM B9+MARG 3.1-4 CM,11444,CPT,761,RC,,,,outpatient,,,1930.94,193.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1628.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3303.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1675.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1675.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,1612.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3303.62,,facility
PURE TONE AUDIOMETRY AIR,92552,CPT,471,RC,,,,outpatient,,,152.14,15.21,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,131.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,266.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,134.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,134.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,425,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,129.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,127.33,448,,facility
CHEMO IV PUSH SNGL DRUG,96409,CPT,331,RC,,,,outpatient,,,403.35,40.34,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,291.03,272.45,297.44,186,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,498.56,498.56,498.56,20,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,459.61,459.61,459.61,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,316.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,316.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,325.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,411.31,411.31,411.31,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,261.74,233.91,261.74,19,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,316.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,660.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,335.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,345,345,345,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,295.37,295.37,297.44,103,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,316.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,335.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1603,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,322.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,316.12,1603,,facility
ASSAY GROWTH HORMONE (HGH),83003,CPT,301,RC,,,,outpatient,,,20.84,2.08,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,14.83,14.83,14.83,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,202.13,202.13,202.13,1 through 10,percent of total billed charges,,,33.6,,29.9,29.9,29.9,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,34.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,14.83,14.83,14.83,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.02,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,16.67,448,,facility
IMMUNOFIX E-PHORESIS SERUM,86334,CPT,302,RC,,,,outpatient,,,27.93,2.79,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.87,19.87,19.87,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,23.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,14.26,14.26,56.5,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,27.8,8.98,35.95,1 through 10,percent of total billed charges,,,34.6,,38.84,31.24,40.77,11,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,46.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,23.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.87,19.87,19.87,37,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,23.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,48.28,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,22.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,22.34,448,,facility
DEB SKIN BONE AT FX SITE,11012,CPT,450,RC,,,,outpatient,,,3384.19,338.42,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2779.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2779.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2863.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2779.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,5810.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2946.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2779.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2946.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2835.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,5810.16,,facility
FUNGI IDENTIFICATION MOLD,87107,CPT,306,RC,,,,outpatient,,,12.9,1.29,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,70.56,70.56,70.56,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,70.56,70.56,70.56,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,21.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9.18,9.18,9.18,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.3,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,10.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,10.32,448,,facility
DEHYDROEPIANDROSTERONE,82626,CPT,301,RC,,,,outpatient,,,31.59,3.16,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,22.48,22.48,22.48,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,29.9,29.9,29.9,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,25.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,52.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,26.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,22.48,22.48,22.48,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,25.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,26.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,54.6,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,25.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,25.27,448,,facility
"INJ. RIABNI, 10 MG",Q5123,HCPCS,636,RC,,,,outpatient,,,50.47,5.05,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,18.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,15259.93,15259.93,15259.93,96,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,79.08,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.53,448,,facility
MSH2 GENE FULL SEQ,81295,CPT,310,RC,,,,outpatient,,,477.13,47.71,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,381.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,381.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,393.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,381.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,797.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,404.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,381.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,404.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,667.98,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,389.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,381.7,797.75,,facility
ASSAY OF HALOPERIDOL,80173,CPT,301,RC,,,,outpatient,,,19.73,1.97,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,32.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,31.47,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,16.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,15.78,448,,facility
CHIMERISM ANAL NO CELL SELEC,81267,CPT,310,RC,,,,outpatient,,,259.33,25.93,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,184.53,184.53,184.53,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,207.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,207.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,213.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,1059.7,1059.7,1059.7,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,207.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,433.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,219.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,184.53,184.53,391.84,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,207.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,219.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,448.21,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,211.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,207.46,448.21,,facility
X-RAY EXAM L-S SPINE 2/3 VWS,72100,CPT,320,RC,,,,outpatient,,,130.94,13.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,528.64,435.84,528.64,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,487.34,487.34,487.34,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,359.57,277.54,471.65,18,percent of total billed charges,,,33.6,,436.13,436.13,436.13,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,277.54,277.54,277.54,11,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,23.45,23.45,24.41,22,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,448,,facility
NJX AA&/STRD NRV NRVTG SI JT,64451,CPT,361,RC,,,,outpatient,,,823.63,82.36,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,675.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,675.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,695.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,675.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1411.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,716.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,675.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,716.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2712,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,689.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,2712,,facility
PROCTOSIGMOIDOSCOPY VOLVUL,45321,CPT,750,RC,,,,outpatient,,,3344.05,334.41,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,2656.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2656.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2736.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2656.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,5552.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2815.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2656.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2815.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9389,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,2709.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,9389,,facility
CT UPPER EXTREMITY W/O DYE,73200,CPT,352,RC,,,,outpatient,,,130.94,13.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,403,,,,,,,case rate,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,371,,,,,,,case rate,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,875,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1050,,,,,,,case rate,NTE Percentage + Reimbursement Rate 85.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,85.12,85.12,85.12,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1522,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,1522,,facility
TIS TRNFR E/N/E/L 10 SQ CM/<,14060,CPT,761,RC,,,,outpatient,,,2171.91,217.19,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1027,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1519,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1974.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1974.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2033.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1974.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,4127.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2093.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,814.48,814.48,814.48,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1974.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2093.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,2014.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,4127.08,,facility
EXT ECG>48HR<7D RECORDING,93242,CPT,730,RC,,,,outpatient,,,47.76,4.78,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,34.44,34.44,34.44,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,74.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9.42,9.42,9.97,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,389,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,36.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.74,448,,facility
RPR F/E/E/N/L/M 5.1-7.5 CM,12014,CPT,761,RC,,,,outpatient,,,238.44,23.84,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,197.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,401.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,203.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,203.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,195.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,192.01,1173,,facility
PSYTX W PT 45 MINUTES,90834,CPT,914,RC,,,,outpatient,,,189.89,18.99,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,140.97,140.97,152.83,52,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,169.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,169.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,174.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,169.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,355.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,180.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,367.5,367.5,367.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,169.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,180.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,173.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,169.87,448,,professional
ACETYLCHOLN RCPTR MODLG ANTB,86043,CPT,302,RC,,,,outpatient,,,15.06,1.51,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.72,10.72,10.72,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.09,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.05,448,,facility
WET MOUNTS/ W PREPARATIONS,Q0111,HCPCS,306,RC,,,,outpatient,,,22.2,2.22,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.64,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.54,448,,facility
ASSAY OF THYROID (T3 OR T4),84479,CPT,301,RC,,,,outpatient,,,8.09,0.81,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.75,5.75,5.75,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,70.56,27.98,119.91,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,17.97,17.81,70.56,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,13.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.75,5.75,5.75,23,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.97,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,6.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,6.47,448,,facility
RPR S/N/AX/GEN/TRNK 2.5CM/<,12001,CPT,761,RC,,,,outpatient,,,238.44,23.84,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,197.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,401.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,203.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,88.48,88.48,88.48,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,203.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,195.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,192.01,1173,,facility
PEDICLE E/N/E/L/NTRORAL,15576,CPT,761,RC,,,,outpatient,,,2171.91,217.19,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1027,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1519,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1974.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1974.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2033.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1974.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,4127.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2093.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1974.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2093.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,2014.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,4127.08,,facility
THROMBOLYTIC THERAPY STROKE,37195,CPT,450,RC,,,,outpatient,,,403.35,40.34,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,316.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,316.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,325.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,316.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,660.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,335.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,316.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,335.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,322.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,316.12,660.69,,facility
TREAT KNEECAP DISLOCATION,27562,CPT,450,RC,,,,outpatient,,,280.86,28.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,243.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,493.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,240.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,236.08,1173,,facility
SAME DAY NB DISCHARGE,99463,CPT,722,RC,,,,inpatient,,,157.44,15.74,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Short Stay Lesser of + Days Threshold 1.00 + Stoploss First Dollar + Reimbursement Rate 57.00 + Basic Per Diem + Fixed Rate 5000.00 + Fixed Amount 157464.00,,,,0,other,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,Short Stay Lesser of + Days Threshold 1.00 + Stoploss First Dollar + Reimbursement Rate 72.00 + Basic Per Diem + Fixed Rate 10000.00 + Fixed Amount 56687.00,,,,0,other,NTE Percentage + Reimbursement Rate 85.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,47.3,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,facility
HLTH BHV IVNTJ FAM 1ST 30,96167,CPT,916,RC,,,,outpatient,,,34.18,3.42,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,26.14,26.14,35.86,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,74.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,38.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,38.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.86,448,,professional
DIPROPYLACETIC ACID FREE,80165,CPT,301,RC,,,,outpatient,,,16.93,1.69,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,28.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.26,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.54,448,,facility
PUNCH BX SKIN SINGLE LESION,11104,CPT,361,RC,,,,outpatient,,,474.9,47.49,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,350.55,350.55,350.55,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,400.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,813.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,412.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,412.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2440,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,396.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,389.05,2440,,facility
INCAL BX EYELID SKN LID MRGN,67810,CPT,761,RC,,,,outpatient,,,346.95,34.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,303.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,303.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,312.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,303.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,634.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,322,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,303.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,322,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,309.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,303.77,1173,,facility
MITOMYCIN INJECTION,J9280,HCPCS,636,RC,,,,outpatient,,,67.71,6.77,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,34.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,34.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,34.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,71.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,36.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,34.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,36.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,99.65,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,34.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,34.11,448,,facility
TREAT KNEE DISLOCATION,27550,CPT,761,RC,,,,outpatient,,,280.86,28.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,243.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,493.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,240.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,236.08,1173,,facility
HARVEST STEM CELL CONCENTRTE,38215,CPT,815,RC,,,,inpatient,,,517.01,51.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Short Stay Lesser of + Days Threshold 1.00 + Stoploss First Dollar + Reimbursement Rate 57.00 + Basic Per Diem + Fixed Rate 5000.00 + Fixed Amount 157464.00,,,,0,other,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,Short Stay Lesser of + Days Threshold 1.00 + Stoploss First Dollar + Reimbursement Rate 72.00 + Basic Per Diem + Fixed Rate 10000.00 + Fixed Amount 56687.00,,,,0,other,NTE Percentage + Reimbursement Rate 85.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,47.3,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,facility
DIAGNOSTIC LARYNGOSCOPY,31505,CPT,761,RC,,,,outpatient,,,235.91,23.59,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,191.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,191.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,196.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,191.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,399.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,202.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,191.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,202.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,194.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,191.04,448,,facility
ASSAY OF LEAD,83655,CPT,301,RC,,,,outpatient,,,15.14,1.51,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.77,10.77,10.77,70,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,47.79,47.79,47.79,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,27.22,27.22,42.77,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,11.76,11.76,27.22,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,40.5,40.5,40.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.77,10.77,10.77,84,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.16,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.11,448,,facility
JOHN CUNNINGHAM ANTIBODY,86711,CPT,302,RC,,,,outpatient,,,21.11,2.11,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,105.02,105.02,105.02,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,35.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.02,15.02,15.02,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,31.1,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,16.89,448,,facility
PACLITAXEL PROTEIN BOUND,J9264,HCPCS,636,RC,,,,outpatient,,,16.55,1.66,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,20838.21,20838.21,20838.21,946,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,6.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,13.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.11,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,6.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,6.59,448,,facility
TREAT HAND DISLOCATION,26670,CPT,450,RC,,,,outpatient,,,280.86,28.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,243.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,493.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,240.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,236.08,493.41,,facility
ANOSCOPY REMOVE FOR BODY,46608,CPT,750,RC,,,,outpatient,,,1088.51,108.85,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,890.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,890.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,916.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,890.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1860.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,943.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,890.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,943.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3821,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,907.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3821,,facility
HLA II TYPE 1 AG EQUIV LR,81377,CPT,310,RC,,,,outpatient,,,118.43,11.84,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,94.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,94.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,97.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,94.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,198.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,94.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,198.36,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,96.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,94.74,448,,facility
SMN1 GENE FULL GENE SEQUENCE,81336,CPT,310,RC,,,,outpatient,,,376.69,37.67,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,301.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,301.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,310.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,301.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,629.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,319.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,301.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,319.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,527.36,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,307.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,301.35,629.82,,facility
REPAIR BLOOD VESSEL DIR UXTR,35206,CPT,450,RC,,,,outpatient,,,3796.26,379.63,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1268,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1793,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3021.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3021.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3112.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3021.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,6315.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3203.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3021.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3203.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3082.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,6315.75,,facility
NOS EACH ORGANISM AG IA,87449,CPT,306,RC,,,,outpatient,,,14.98,1.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,198,198,198,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,26.27,26.27,26.27,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.66,10.66,10.66,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.9,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.98,448,,facility
PROCALCITONIN (PCT),84145,CPT,301,RC,,,,outpatient,,,34.03,3.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,24.21,24.21,24.21,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,182.72,107.52,215.04,1 through 10,percent of total billed charges,,,33.6,,99.54,99.54,107.52,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,107.52,33.6,108.48,15,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,27.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,56.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,28.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,160,160,160,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,24.21,24.21,24.21,349,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,27.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,28.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,57.89,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,27.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,27.22,448,,facility
INC&RMVL FB SUBQ TISS SMPL,10120,CPT,761,RC,,,,outpatient,,,474.9,47.49,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,400.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,813.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,412.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,412.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,396.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,389.05,1173,,facility
CRYOPRESERVE STEM CELLS,38207,CPT,310,RC,,,,outpatient,,,517.01,51.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,422.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,422.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,434.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,337.34,337.34,337.34,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,332.61,332.61,332.61,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,422.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,882.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,447.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,422.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,447.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,430.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,422.23,882.46,,facility
ASSAY OF UREA NITROGEN,84520,CPT,301,RC,,,,outpatient,,,4.94,0.49,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.51,3.51,3.51,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,7.9,7.9,7.9,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,37.69,22.18,37.69,1 through 10,percent of total billed charges,,,33.6,,22.18,22.18,22.18,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,22.18,19.49,43.73,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,8.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.51,3.51,3.51,46,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.54,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,4.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,3.95,448,,facility
COMPL OPH EXAM GENERAL ANES,92018,CPT,920,RC,,,,outpatient,,,2783.1,278.31,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2275.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2275.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2343.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2275.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,4755.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2411.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2275.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2411.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,422,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,2320.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,422,4755.57,,facility
DXA BONE DENSITY AXL VRT FX,77085,CPT,320,RC,,,,outpatient,,,130.94,13.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,448,,facility
BLASTOMYCES ANTIBODY,86612,CPT,302,RC,,,,outpatient,,,16.13,1.61,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,26.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.88,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.9,448,,facility
ASSAY OF LACTIC ACID,83605,CPT,301,RC,,,,outpatient,,,14.46,1.45,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.29,10.29,10.29,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,129.62,76.27,637.81,57,percent of total billed charges,,,33.6,,275.32,76.27,451.58,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,375.31,76.27,375.31,34,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,24.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,558.5,113.5,1117,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.29,10.29,10.29,439,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,23.08,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,11.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.57,448,,facility
RBC PRETX INCUBATJ W/ENZYMES,86971,CPT,302,RC,,,,outpatient,,,203.43,20.34,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,167.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,1346.4,728.02,1346.4,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,925.65,925.65,925.65,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,340.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,172.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,172.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,377,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,166.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,163.06,448,,facility
CLTX SHO DSLC W/MNPJ W/ANES,23655,CPT,761,RC,,,,outpatient,,,1914.16,191.42,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1585.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3216.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1631.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1631.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,1569.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3216.38,,facility
PRIN CARE MGMT STAFF 1ST 30,99426,CPT,510,RC,,,,outpatient,,,106.16,10.62,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,97.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,97.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,97.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,203.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,97.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,99.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,97.23,448,,facility
VEEG 2-12 HR INTMT MNTR,95712,CPT,740,RC,,,,outpatient,,,373.83,37.38,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,357.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,357.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,367.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,357.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,746.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,378.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,357.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,378.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1175,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,364.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,357.13,1175,,facility
EGD PLACE GASTROSTOMY TUBE,43246,CPT,750,RC,,,,outpatient,,,2266.24,226.62,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,1664.42,1558.21,1689.3,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,1836.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1836.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1891.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1836.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3838.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1946.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,1689.3,1689.3,1727.99,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1836.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1946.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3821,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1873.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3838.31,,facility
T3 REVERSE,84482,CPT,301,RC,,,,outpatient,,,19.7,1.97,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,14.02,14.02,14.02,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,32.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,34.06,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,16.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,15.76,448,,facility
DESTRUCTION ANAL LESION(S),46924,CPT,761,RC,,,,outpatient,,,3344.05,334.41,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2656.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2656.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2736.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2656.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,5552.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2815.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2656.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2815.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,2709.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,5552.02,,facility
EMERGENCY DEPT VISIT MOD MDM,99284,CPT,450,RC,,,,outpatient,,,527.5,52.75,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,373.62,349.77,375.75,1282,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,1614,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,3451,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,1817.08,1817.08,1817.08,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1200,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1500,,,,,,,case rate,NTE Percentage + Reimbursement Rate 85.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,399.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,399.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,411.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,2074.44,1220.69,2074.45,29,percent of total billed charges,,,33.6,,1220.69,1162.56,3528.92,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,1220.69,1162.56,1220.69,16,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,399.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,834.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,423.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,1816.5,1730,1816.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,741.37,741.37,741.37,1 through 10,percent of total billed charges,,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,246.57,245.82,379.2,956,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,399.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,423.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2893,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,407.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,399.34,3451,,facility
SPECIAL TELETX PORT PLAN,77321,CPT,333,RC,,,,outpatient,,,440.06,44.01,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,358.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,358.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,369.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,358.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,748.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,379.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,358.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,379.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,48815,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,365.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,358.36,48815,,facility
URINALYSIS VOLUME MEASURE,81050,CPT,307,RC,,,,outpatient,,,4.55,0.46,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.24,3.24,3.24,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,3.7,3.36,3.7,1 through 10,percent of total billed charges,,,33.6,,3.36,3.36,3.36,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,3.36,3.36,3.36,1 through 10,percent of total billed charges,,,34.6,,3.99,3.99,3.99,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,7.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.24,3.24,98.45,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.49,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,3.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,3.64,448,,facility
DRUG SCREEN QUANT TIAGABINE,80199,CPT,301,RC,,,,outpatient,,,33.89,3.39,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,27.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,56.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,28.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,27.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,28.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,47.44,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,27.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,27.11,448,,facility
OLIGOCLONAL BANDS,83916,CPT,301,RC,,,,outpatient,,,34.24,3.42,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,27.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,57.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,29.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,24.36,24.36,24.36,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,27.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,29.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,47.93,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,27.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,27.39,448,,facility
DEMO&/EVAL PT USE INHALER,94664,CPT,410,RC,,,,inpatient,,,254.03,25.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Short Stay Lesser of + Days Threshold 1.00 + Stoploss First Dollar + Reimbursement Rate 57.00 + Basic Per Diem + Fixed Rate 5000.00 + Fixed Amount 157464.00,,,,0,other,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,Short Stay Lesser of + Days Threshold 1.00 + Stoploss First Dollar + Reimbursement Rate 72.00 + Basic Per Diem + Fixed Rate 10000.00 + Fixed Amount 56687.00,,,,0,other,NTE Percentage + Reimbursement Rate 85.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,47.3,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,391.51,391.51,391.51,1 through 10,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,14.52,14.52,14.52,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,facility
EGD INJECTION VARICES,43243,CPT,750,RC,,,,outpatient,,,2266.24,226.62,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,1836.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1836.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1891.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1836.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3838.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1946.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1836.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1946.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3821,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1873.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3838.31,,facility
VOLTAGE-GTD CA CHNL ANTB EA,86596,CPT,302,RC,,,,outpatient,,,15.06,1.51,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,36.48,36.48,36.48,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.72,10.72,10.72,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.2,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.05,448,,facility
RPLC GTUBE NO REVJ TRC,43762,CPT,761,RC,,,,outpatient,,,294.35,29.44,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,213.4,213.4,231.35,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,239.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,239.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,246.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,239.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,499.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,253.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,239.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,253.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,243.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,239.12,1173,,facility
PTEN GENE DUP/DELET VARIANT,81323,CPT,310,RC,,,,outpatient,,,375,37.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,300,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,300,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,309,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,300,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,627,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,318,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,300,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,318,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,525,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,306,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,300,627,,facility
X-RAY EXAM OF FEMUR 1,73551,CPT,320,RC,,,,outpatient,,,108.23,10.82,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,85.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,174.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,84.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,83.29,448,,facility
PRGRMG DEV EVAL SCRMS IP,93285,CPT,480,RC,,,,outpatient,,,44.91,4.49,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,35.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,74.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1463,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,36.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.71,1463,,facility
DESTRUCTION ANAL LESION(S),46910,CPT,360,RC,,,,outpatient,,,2171.91,217.19,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,1974.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1974.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2033.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1974.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,4127.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2093.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1974.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2093.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3821,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,2014.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,4127.08,,facility
RPR S/N/AX/GEN/TRK7.6-12.5CM,12004,CPT,761,RC,,,,outpatient,,,238.44,23.84,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,197.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,401.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,203.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,203.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,195.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,192.01,1173,,facility
CLTX RDL HEAD SUBLXTJ NRSEMD,24640,CPT,761,RC,,,,outpatient,,,280.86,28.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,243.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,493.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,240.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,236.08,493.41,,facility
STEM CELLS TOTAL COUNT,86367,CPT,302,RC,,,,outpatient,,,97.23,9.72,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,77.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,77.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,80.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,314.16,314.16,314.16,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,77.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,162.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,82.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,69.18,69.18,69.18,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,77.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,82.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,136.12,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,79.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,77.78,448,,facility
EGD CAUTERY TUMOR POLYP,43250,CPT,750,RC,,,,outpatient,,,2266.24,226.62,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,1836.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1836.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1891.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1836.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3838.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1946.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1836.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1946.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3821,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1873.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3838.31,,facility
BODY FLUID SPECIFIC GRAVITY,84315,CPT,301,RC,,,,outpatient,,,4.1,0.41,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,6.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.74,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,3.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,3.28,448,,facility
EXC EXCESSIVE SKN OTHER AREA,15839,CPT,510,RC,,,,outpatient,,,3384.19,338.42,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1027,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1519,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2779.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2779.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2863.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2779.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,5810.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2946.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2779.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2946.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,2835.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,5810.16,,facility
RMVL/BIVLV FULL ARM/LEG CAST,29705,CPT,761,RC,,,,outpatient,,,319.85,31.99,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,267.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,267.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,275.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,267.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,559.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,283.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,267.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,283.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,273.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,267.68,559.45,,facility
"PLASMAPROTEIN FRACT,5%,250ML",P9048,HCPCS,390,RC,,,,outpatient,,,127.55,12.76,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,107,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.15,448,,facility
FIBRINOLYTIC ANTIPLASMIN,85410,CPT,305,RC,,,,outpatient,,,9.64,0.96,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,7.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,16.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,7.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.64,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,7.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,7.71,448,,facility
SUGARS SINGLE QUAL,84376,CPT,301,RC,,,,outpatient,,,6.88,0.69,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.89,4.89,4.89,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,11.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.89,4.89,4.89,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.88,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.5,448,,facility
NJX INTERLAMINAR LMBR/SAC,62323,CPT,361,RC,,,,outpatient,,,823.63,82.36,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,635.65,623.15,635.65,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,675.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,675.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,695.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,1337.28,1337.28,1337.28,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,675.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1411.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,716.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,616.7,616.7,616.7,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,675.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,716.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2712,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,689.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,2712,,facility
UNLISTED MR PROCEDURE,76498,CPT,610,RC,,,,outpatient,,,108.23,10.82,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1025,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1350,,,,,,,case rate,NTE Percentage + Reimbursement Rate 85.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,85.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,174.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2407,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,84.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,83.29,2407,,facility
ASSAY OF HOMOCYSTEINE,83090,CPT,301,RC,,,,outpatient,,,22.4,2.24,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.94,15.94,15.94,15,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,34.32,21.84,34.32,1 through 10,percent of total billed charges,,,33.6,,34.45,34.45,73.25,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,37.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.94,15.94,15.94,13,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.45,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.92,448,,facility
HBA1/HBA2 FULL GENE SEQUENCE,81259,CPT,310,RC,,,,outpatient,,,750,75,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,600,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,600,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,618,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,600,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1254,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,636,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,600,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,636,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1050,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,612,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1254,,facility
RPR F/E/E/N/L/M 2.5 CM/<,12011,CPT,761,RC,,,,outpatient,,,238.44,23.84,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,197.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,401.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,203.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,88.48,88.48,88.48,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,203.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,195.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,192.01,448,,facility
DEOXYRIBONUCLEASE ANTIBODY,86215,CPT,302,RC,,,,outpatient,,,16.56,1.66,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.79,11.79,11.79,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.61,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.25,448,,facility
ASSAY OF TSI GLOBULIN,84445,CPT,301,RC,,,,outpatient,,,63.58,6.36,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,45.24,45.24,45.24,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,342.79,342.79,342.79,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,50.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,50.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,52.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,73.39,46.7,306.77,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,46.95,46.95,195.22,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,50.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,106.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,53.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,45.24,45.24,45.24,18,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,50.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,53.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,109.87,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,51.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,50.86,448,,facility
ASSAY OF VOLATILES,84600,CPT,301,RC,,,,outpatient,,,21.39,2.14,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,35.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,34.74,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.11,448,,facility
TEST FOR G6PD ENZYME,82960,CPT,301,RC,,,,outpatient,,,7.56,0.76,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,36.43,36.43,36.43,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,12.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.38,5.38,5.38,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.07,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,6.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,6.05,448,,facility
TREAT BIG TOE FRACTURE,28490,CPT,450,RC,,,,outpatient,,,280.86,28.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,243.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,493.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,240.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,236.08,1173,,facility
ALYS SMPL CN NPGT PRGRMG,95976,CPT,920,RC,,,,outpatient,,,44.91,4.49,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,32.72,32.72,35.71,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,74.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,32.24,32.24,32.24,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,422,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,36.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.71,448,,facility
EXC TR-EXT B9+MARG 2.1-3CM,11403,CPT,761,RC,,,,outpatient,,,837.95,83.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,625.13,617.33,637.68,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,677.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,677.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,698.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,677.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1416.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,718.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,626.56,626.56,626.56,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,677.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,718.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,691.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1416.43,,facility
REMOVE FOREARM FOREIGN BODY,25248,CPT,450,RC,,,,outpatient,,,1914.16,191.42,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1585.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3216.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1631.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1631.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1569.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3216.38,,facility
"BRACHYTX, STRANDED, P-103",C2640,HCPCS,278,RC,,,,outpatient,,,95.24,9.52,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,66,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,61,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,87.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,87.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,90.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,87.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,183.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,93.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,87.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,93.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,89.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,87.83,183.56,,facility
INC&RMVL FB SUBQ TISS COMP,10121,CPT,761,RC,,,,outpatient,,,1930.94,193.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1628.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3303.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1675.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1675.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,1612.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3303.62,,facility
ECHO GUIDE FOR ARTERY REPAIR,76936,CPT,402,RC,,,,outpatient,,,373.83,37.38,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,206.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,206.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,212.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,206.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,431.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,219.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,206.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,219.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,465,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,210.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,206.65,465,,facility
REMOVE FOREIGN BODY FROM EYE,65222,CPT,761,RC,,,,outpatient,,,152.14,15.21,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,131.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,266.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,134.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,134.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,129.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,127.33,448,,facility
MULTIPLE SLEEP LATENCY TEST,95805,CPT,740,RC,,,,outpatient,,,638.35,63.84,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,821.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,821.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,846.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,2499.55,2499.55,2499.55,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,1604.83,1604.83,1604.83,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,821.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1717.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,871.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,821.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,871.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1175,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,838.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1717.69,,facility
EXCISE LWR JAW CYST W/REPAIR,21047,CPT,510,RC,,,,outpatient,,,6974.64,697.46,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5665.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5665.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5835.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5665.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,11841.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6005.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5665.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6005.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,5778.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,11841.12,,facility
REPOS PREV IMPLTBL SUBQ DFB,33273,CPT,361,RC,,,,outpatient,,,4677.03,467.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1027,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1519,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,3576.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3576.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3683.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3576.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,7474.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3791.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3576.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3791.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10137,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,3648.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,10137,,facility
GJB6 GENE COM VARIANTS,81254,CPT,310,RC,,,,outpatient,,,43.75,4.38,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,61.25,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35,448,,facility
CARDIOPULM EXERCISE TESTING,94621,CPT,460,RC,,,,outpatient,,,373.83,37.38,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,296.21,273.22,357.13,21,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,2439.68,2439.68,2439.68,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,357.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,357.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,367.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,2012.74,2012.74,2012.74,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,357.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,746.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,378.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,71.71,71.71,73.52,19,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,357.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,378.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,611,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,364.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,357.13,746.4,,facility
BLOOD GASES ANY COMBINATION,82803,CPT,301,RC,,,,outpatient,,,32.59,3.26,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,23.19,23.19,23.19,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,182.16,115.92,197,26,percent of total billed charges,,,33.6,,115.92,107.14,115.92,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,115.92,89.84,228.59,16,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,26.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,54.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,27.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,172.5,172.5,172.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,23.19,23.19,23.19,245,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,26.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,27.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,45.62,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,26.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,26.07,448,,facility
REMOVAL BILIARY DRG CATH,47537,CPT,361,RC,,,,outpatient,,,1079.61,107.96,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,868.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,868.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,894.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,868.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1814.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,920.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,868.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,920.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3821,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,885.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3821,,facility
PSYTX W PT 60 MINUTES,90837,CPT,914,RC,,,,outpatient,,,189.89,18.99,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,140.97,140.97,152.83,102,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,169.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,169.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,174.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,169.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,355.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,180.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,169.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,180.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,173.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,169.87,448,,professional
INHIBIN A,86336,CPT,302,RC,,,,outpatient,,,19.49,1.95,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.87,13.87,13.87,11,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,102.48,102.48,102.48,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,12.1,12.1,25.54,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,32.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.87,13.87,13.87,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,33.67,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,15.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,15.59,448,,facility
TREAT THIGH FX GROWTH PLATE,27516,CPT,450,RC,,,,outpatient,,,280.86,28.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,243.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,493.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,240.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,236.08,1173,,facility
INTERDENTAL FIXATION,21110,CPT,450,RC,,,,outpatient,,,1816.31,181.63,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1484.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1484.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1529.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1484.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3103.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1574.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1484.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1574.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1514.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3103.57,,facility
WEST NILE VIRUS AB IGM,86788,CPT,302,RC,,,,outpatient,,,21.06,2.11,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,63.5,63.5,63.5,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,35.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,14.99,14.99,14.99,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.4,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,16.85,448,,facility
ASSAY OF INSULIN,83527,CPT,301,RC,,,,outpatient,,,16.19,1.62,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,35.62,35.62,35.62,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.97,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.95,448,,facility
M.PNEUMON DNA AMP PROBE,87581,CPT,306,RC,,,,outpatient,,,43.86,4.39,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
TREATMENT OF THIGH FRACTURE,27503,CPT,450,RC,,,,outpatient,,,1914.16,191.42,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1027,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1519,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1585.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3216.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1631.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1631.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1569.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3216.38,,facility
I&D PILONIDAL CYST SIMPLE,10080,CPT,761,RC,,,,outpatient,,,837.95,83.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,577.94,577.94,617.33,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,677.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,677.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,698.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,677.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1416.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,718.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,677.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,718.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,691.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1416.43,,facility
HLA I TYPING COMPLETE HR,81379,CPT,300,RC,,,,outpatient,,,419.23,41.92,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,335.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,335.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,345.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,335.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,700.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,355.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,335.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,355.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,724.59,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,342.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,335.38,724.59,,facility
EZH2 GENE COMMON VARIANTS,81237,CPT,310,RC,,,,outpatient,,,219.25,21.93,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,175.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,175.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,180.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,175.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,366.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,185.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,175.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,185.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,306.95,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,178.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,175.4,448,,facility
BCR/ABL1 GENE MAJOR BP,81206,CPT,310,RC,,,,outpatient,,,204.95,20.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,145.84,145.84,145.84,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,163.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,163.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,168.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,163.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,342.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,173.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,358.89,358.89,358.89,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,163.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,173.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,354.24,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,167.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,163.96,448,,facility
T CELL ABSOLUTE COUNT/RATIO,86360,CPT,302,RC,,,,outpatient,,,58.73,5.87,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,41.79,41.79,41.79,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,64.31,64.31,64.31,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,46.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,46.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,48.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,31.15,31.15,31.15,1 through 10,percent of total billed charges,,,33.6,,41.79,41.79,41.79,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,288.04,288.04,288.04,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,46.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,98.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,49.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,41.79,41.79,41.79,27,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,46.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,49.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,101.52,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,47.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,46.98,448,,facility
AMPUTATION OF FINGER/THUMB,26951,CPT,761,RC,,,,outpatient,,,3855.04,385.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3131.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3131.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3225.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3131.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,6544.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3319.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3131.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3319.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,3194.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,6544.81,,facility
ASSAY OF FREE TESTOSTERONE,84402,CPT,301,RC,,,,outpatient,,,31.84,3.18,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,22.66,22.66,22.66,39,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,54.28,54.28,54.28,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,48.58,20.59,48.58,16,percent of total billed charges,,,33.6,,123.65,123.65,123.65,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,30.91,13.1,31.19,15,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,25.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,53.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,19.32,19.32,19.32,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,22.66,22.66,22.66,50,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,25.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,55.04,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,25.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,25.47,448,,facility
HEMODIALYSIS ONE EVALUATION,90935,CPT,821,RC,,,,outpatient,,,832.26,83.23,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,613.94,605.88,613.94,23,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,656.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,656.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,676.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,656.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1372.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,696.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,61.36,61.36,61.36,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,656.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,696.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1544,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,669.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1544,,facility
X-RAY EXAM OF HAND,73120,CPT,320,RC,,,,outpatient,,,130.94,13.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,18.87,18.87,18.87,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,448,,facility
THER NMA RDCTJ INTUS/OBSTRCJ,74283,CPT,320,RC,,,,outpatient,,,218.83,21.88,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,172.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,350.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,177.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,1367.5,1367.5,1367.5,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,177.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,171.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,167.87,448,,facility
HERPES SIMPLEX TYPE 2 TEST,86696,CPT,302,RC,,,,outpatient,,,24.19,2.42,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,17.21,17.21,17.21,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,20.59,20.59,42.71,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,13.1,13.1,13.1,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,40.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,20.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,17.21,17.21,17.21,12,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,20.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,41.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,19.35,448,,facility
TISS TRNSGLTMNASE EA IG CLAS,86364,CPT,302,RC,,,,outpatient,,,14.41,1.44,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9,9,10.26,36,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,10.62,10.62,55.46,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,9.5,6.1,38.02,36,percent of total billed charges,,,33.6,,6.05,6.05,6.05,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,6.05,6.05,6.1,19,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,24.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,9,9,9,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9,9,10.26,141,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.18,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,11.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.53,448,,facility
ASSAY OF BIOTINIDASE,82261,CPT,301,RC,,,,outpatient,,,21.09,2.11,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.01,15.01,15.01,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,35.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.01,15.01,15.01,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.45,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,16.87,448,,facility
STREP A ASSAY W/OPTIC,87880,CPT,306,RC,,,,outpatient,,,20.66,2.07,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,34.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.93,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,16.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,16.53,448,,facility
ASSAY AMINOLEVULINIC ACID,82135,CPT,301,RC,,,,outpatient,,,20.56,2.06,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,14.63,14.63,14.63,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,34.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.54,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,16.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,16.45,448,,facility
ACETYLCHOLN RCPTR BNDNG ANTB,86041,CPT,302,RC,,,,outpatient,,,23,2.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.37,16.37,16.37,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.2,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.4,448,,facility
BRCA1&2 GEN FULL SEQ DUP/DEL,81162,CPT,310,RC,,,,outpatient,,,2281.1,228.11,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1824.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1824.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1879.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1824.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3814,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1934.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1824.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1934.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3942.63,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1861.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3942.63,,facility
KIT GENE TARGETED SEQ ANALYS,81272,CPT,310,RC,,,,outpatient,,,411.89,41.19,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,329.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,329.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,339.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,329.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,688.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,349.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,329.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,349.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,576.64,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,336.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,329.51,688.68,,facility
SMPD1 GENE COMMON VARIANTS,81330,CPT,310,RC,,,,outpatient,,,58.75,5.88,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,48.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,98.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,49.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,49.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,82.25,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,47.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,47,448,,facility
X-RAY EXAM CHEST 2 VIEWS,71046,CPT,320,RC,,,,outpatient,,,108.23,10.82,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,77.25,76.83,83.29,724,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,437.12,437.12,437.12,35,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,402.97,40.3,402.97,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,85.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,360.62,229.49,389.99,46,percent of total billed charges,,,33.6,,229.49,229.49,360.62,13,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,229.49,229.49,231.54,37,percent of total billed charges,,,34.6,,260.22,260.22,260.22,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,174.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,341.5,341.5,341.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,143.43,143.43,143.43,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,18.87,18.87,19.41,574,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,84.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,83.29,448,,facility
DX BRONCHOSCOPE/LAVAGE,31624,CPT,750,RC,,,,outpatient,,,2021.43,202.14,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,1513.06,1478.43,1602.81,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,1703.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1703.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1754.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1703.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3560.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1805.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,1535.67,1535.67,1602.81,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1703.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1805.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3821,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1737.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3821,,facility
PLCG2 GENE COMMON VARIANTS,81320,CPT,310,RC,,,,outpatient,,,364.2,36.42,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,291.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,291.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,300.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,291.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,608.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,308.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,291.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,308.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,509.88,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,297.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,291.36,608.94,,facility
INTRANASAL BIOPSY,30100,CPT,510,RC,,,,outpatient,,,1816.31,181.63,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1484.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1484.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1529.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1484.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3103.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1574.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1484.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1574.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,1514.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3103.57,,facility
TELEHEALTH FACILITY FEE,Q3014,HCPCS,780,RC,,,,outpatient,,,66,6.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
UNLISTED PROCEDURE RECTUM,45999,CPT,450,RC,,,,outpatient,,,1088.51,108.85,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,799.94,799.94,799.94,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,890.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,890.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,916.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,890.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1860.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,943.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,890.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,943.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,907.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1860.16,,facility
TREAT KNEECAP DISLOCATION,27560,CPT,761,RC,,,,outpatient,,,280.86,28.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,243.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,493.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,240.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,236.08,1173,,facility
MYELOGRAPHY LUMBAR INJECTION,62302,CPT,361,RC,,,,outpatient,,,953.6,95.36,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,750.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,750.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,772.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,750.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1568.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,795.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,750.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,795.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2712,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,765.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,2712,,facility
TREAT THUMB FRACTURE,26645,CPT,761,RC,,,,outpatient,,,1914.16,191.42,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1585.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3216.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1631.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1631.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,1569.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3216.38,,facility
"INJ RUXIENCE, 10 MG",Q5119,HCPCS,636,RC,,,,outpatient,,,24.06,2.41,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,16.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,9292.8,9292.8,9292.8,300,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,33.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,50.72,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,16.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,16.16,448,,facility
CLTX ULNAR SHFT FX W/O MNPJ,25530,CPT,761,RC,,,,outpatient,,,280.86,28.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,243.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,493.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,240.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,236.08,1173,,facility
CLTX MEDIAL ANKLE FX,27760,CPT,761,RC,,,,outpatient,,,280.86,28.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,243.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,493.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,240.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,236.08,1173,,facility
NJX INTERLAMINAR LMBR/SAC,62322,CPT,761,RC,,,,outpatient,,,1085.56,108.56,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,846.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,846.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,871.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,846.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1769.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,897.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,846.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,897.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,863.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1769.16,,facility
ESOPHAGUS MOTILITY STUDY,91010,CPT,750,RC,,,,outpatient,,,638.35,63.84,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,465.55,465.55,504.72,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,357.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,357.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,367.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,1712.3,1712.3,1712.3,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,1089.65,1089.65,1089.65,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,357.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,746.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,378.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,1621.5,1621.5,1621.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,123.54,123.54,123.54,14,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,357.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,378.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2440,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,364.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,357.13,2440,,facility
BILIRUBIN DIRECT,82248,CPT,301,RC,,,,outpatient,,,6.28,0.63,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.47,4.47,4.47,154,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,19.47,19.47,160.48,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,17.42,17.42,155.31,44,percent of total billed charges,,,33.6,,11.09,11.09,143.62,18,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,91.39,11.09,91.39,51,percent of total billed charges,,,34.6,,103.63,103.63,190.4,1 through 10,percent of total billed charges,,,45,,4.47,4.47,4.47,1 through 10,percent of total billed charges,,5.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,10.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,16.5,16.5,16.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,6.93,6.93,6.93,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.47,4.47,4.47,656,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.02,448,,facility
CARE MGMT SVC BHVL HLTH COND,99484,CPT,900,RC,,,,outpatient,,,34.18,3.42,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,74.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,38.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,38.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1372,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,36.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.86,1372,,professional
UPR/L XTREMITY ART 2 LEVELS,93922,CPT,921,RC,,,,outpatient,,,152.14,15.21,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,131.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,266.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,134.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,134.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1227,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,129.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,127.33,1227,,facility
IBMFS SEQ ALYS PNL 30 GENES,81441,CPT,310,RC,,,,outpatient,,,3060.7,306.07,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2448.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2448.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2522.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2448.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,5117.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2595.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2448.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2595.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4284.98,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,2497.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,5117.49,,facility
ASSAY OF PROLACTIN,84146,CPT,301,RC,,,,outpatient,,,24.23,2.42,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,17.24,17.24,17.24,56,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,43.66,43.66,43.66,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,39.07,24.86,139.92,20,percent of total billed charges,,,33.6,,89.04,89.04,139.92,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,24.86,24.86,89.04,15,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,40.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,20.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,36.75,36.75,37,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,15.54,15.54,15.54,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,17.24,17.24,17.24,96,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,20.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,41.86,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,19.38,448,,facility
DIAGNOSTIC SIGMOIDOSCOPY,45330,CPT,750,RC,,,,outpatient,,,1088.51,108.85,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,799.94,399.97,837.43,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,890.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,890.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,916.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,2183.04,2183.04,2183.04,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,890.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1860.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,943.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,2431,1870,2431,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,1021.02,1021.02,1021.02,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,811.89,0.12,837.43,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,890.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,943.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2712,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,907.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,2712,,facility
BRONCH EBUS SAMPLNG 3/> NODE,31653,CPT,361,RC,,,,outpatient,,,4460.06,446.01,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,3568.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3568.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3675.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3568.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,7457.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3782.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3568.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3782.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9389,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,3639.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,9389,,facility
COLONOSCOPY W/LESION REMOVAL,45384,CPT,750,RC,,,,outpatient,,,1405.45,140.55,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1179.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,2393.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1213.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1213.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3821,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1168.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3821,,facility
MNPJ CHEST WALL SBSQ,94668,CPT,410,RC,,,,inpatient,,,152.14,15.21,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Short Stay Lesser of + Days Threshold 1.00 + Stoploss First Dollar + Reimbursement Rate 57.00 + Basic Per Diem + Fixed Rate 5000.00 + Fixed Amount 157464.00,,,,0,other,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,Short Stay Lesser of + Days Threshold 1.00 + Stoploss First Dollar + Reimbursement Rate 72.00 + Basic Per Diem + Fixed Rate 10000.00 + Fixed Amount 56687.00,,,,0,other,NTE Percentage + Reimbursement Rate 85.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,47.3,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.26,31.26,31.26,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,facility
X-RAY EXAM KNEE 4 OR MORE,73564,CPT,320,RC,,,,outpatient,,,130.94,13.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,448,,facility
DRUG ASSAY EVEROLIMUS,80169,CPT,301,RC,,,,outpatient,,,17.16,1.72,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.21,12.21,12.21,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,339.36,339.36,339.36,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,313.24,313.24,313.24,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,28.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.21,12.21,12.21,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.68,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.73,448,,facility
BILIARY ENDO PERQ DX W/SPECI,47552,CPT,361,RC,,,,outpatient,,,9010.51,901.05,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,6195.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6195.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6381.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6195.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,12949.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6567.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6195.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6567.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10137,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,6319.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,12949.24,,facility
TP53 GENE FULL GENE SEQUENCE,81351,CPT,310,RC,,,,outpatient,,,802.31,80.23,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,641.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,641.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,661.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,641.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1341.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,680.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,641.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,680.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1123.24,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,654.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1341.47,,facility
HPYLORI STOOL AG IA,87338,CPT,306,RC,,,,outpatient,,,17.98,1.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.79,12.79,12.79,23,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,46.46,46.46,46.46,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,29.66,29.57,98.99,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,30.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.79,12.79,12.79,13,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,31.08,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.38,448,,facility
ASSAY OF GLUTATHIONE,82978,CPT,301,RC,,,,outpatient,,,19.31,1.93,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,32.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.8,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,15.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,15.45,448,,facility
CT MAXILLOFACIAL W/O & W/DYE,70488,CPT,351,RC,,,,outpatient,,,218.83,21.88,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,403,,,,,,,case rate,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,371,,,,,,,case rate,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,875,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1050,,,,,,,case rate,NTE Percentage + Reimbursement Rate 85.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,172.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,350.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,177.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,177.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1522,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,171.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,167.87,1522,,facility
ASSAY OF PRIMIDONE,80188,CPT,301,RC,,,,outpatient,,,20.74,2.07,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,34.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.84,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,16.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,16.59,448,,facility
NRV CNDJ TST 5-6 STUDIES,95909,CPT,922,RC,,,,outpatient,,,373.83,37.38,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,273.22,273.22,273.22,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,206.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,206.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,212.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,206.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,431.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,219.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,44.5,44.5,47.18,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,206.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,219.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,478,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,210.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,206.65,478,,facility
BIOPSY OF RECTUM,45100,CPT,750,RC,,,,outpatient,,,3344.05,334.41,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,2656.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2656.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2736.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2656.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,5552.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2815.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2656.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2815.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3821,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,2709.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,5552.02,,facility
ALLG SPEC IGE RECOMB EA,86008,CPT,302,RC,,,,outpatient,,,22.41,2.24,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,37.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.75,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.93,448,,facility
APPLICATION CLUBFOOT CAST,29450,CPT,761,RC,,,,outpatient,,,187.66,18.77,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,155.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,155.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,160.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,155.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,325.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,164.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,155.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,164.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,158.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,155.52,448,,facility
CLTX SCAPULAR FX W/O MNPJ,23570,CPT,450,RC,,,,outpatient,,,280.86,28.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,243.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,493.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,240.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,236.08,1173,,facility
FUNGI IDENTIFICATION YEAST,87106,CPT,306,RC,,,,outpatient,,,12.9,1.29,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,21.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9.18,9.18,9.18,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.3,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,10.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,10.32,448,,facility
CLTX POST ANKLE FX,27767,CPT,450,RC,,,,outpatient,,,280.86,28.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,243.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,493.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,240.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,236.08,1173,,facility
STRAPPING OF ELBOW OR WRIST,29260,CPT,450,RC,,,,outpatient,,,72.85,7.29,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,56.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,56.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,58.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,56.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,118,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,59.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,56.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,59.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,57.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,56.46,448,,facility
EXC H-F-NK-SP B9+MARG 0.6-1,11421,CPT,761,RC,,,,outpatient,,,837.95,83.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,617.33,617.33,617.33,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,677.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,677.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,698.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,677.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1416.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,718.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,677.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,718.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,691.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1416.43,,facility
ASSAY OF TRIGLYCERIDES,84478,CPT,301,RC,,,,outpatient,,,7.18,0.72,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.11,5.11,5.11,49,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,21.12,13.44,142.03,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,13.44,13.44,13.56,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.11,5.11,5.11,55,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.41,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.74,448,,facility
COLLECT SWEAT FOR TEST,89230,CPT,300,RC,,,,outpatient,,,64.54,6.45,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,46.88,46,46.88,15,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,69.6,69.6,69.76,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,49.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,49.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,51.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,49.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,104.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,52.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,2.41,2.41,2.47,19,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,49.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,52.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,78.23,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,50.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,49.87,448,,facility
CHEMO ANTI-NEOPL SQ/IM,96401,CPT,331,RC,,,,outpatient,,,83.9,8.39,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,62.45,62.45,62.45,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,232.96,232.96,232.96,11,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,214.76,214.76,214.76,11,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,68.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,68.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,70.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,192.19,192.19,384.38,56,percent of total billed charges,,,33.6,,384.38,384.38,384.38,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,122.3,122.3,244.61,32,percent of total billed charges,,,34.6,,132.13,132.13,138.68,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,68.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,144.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,73.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,64.84,63.38,190.14,122,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,68.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,73.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1603,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,70.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,68.91,1603,,facility
MLH1 GENE KNOWN VARIANTS,81293,CPT,310,RC,,,,outpatient,,,413.75,41.38,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,331,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,331,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,340.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,331,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,691.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,350.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,331,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,350.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,579.25,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,337.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,331,691.79,,facility
NFCT DS VIR RESP RNA 3 TRGT,0240U,CPT,300,RC,,,,outpatient,,,178.29,17.83,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,142.63,142.63,142.63,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 103.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment.",,,,0,other,"Payer contract is 103.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment. + No services performed during 15-month lookback period",,52.8,,51.53,51.53,51.53,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment. + No services performed during 15-month lookback period",,,"Payer contract is 209.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment.",,,,0,other,"Payer contract is 209.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment. + No services performed during 15-month lookback period",,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment. + No services performed during 15-month lookback period",,50,,76,76,76,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment.",142.63,142.63,142.63,1 through 10,other,"Payer contract is 100.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment.",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,249.55,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,"Payer contract is 102.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment.",145.48,145.48,145.48,26,other,"Payer contract is 102.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment.",249.55,448,,facility
WHOLE BLOOD FOR TRANSFUSION,P9010,HCPCS,390,RC,,,,outpatient,,,253.88,25.39,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,188.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,188.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,194.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,188.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,394.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,200.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,278.94,278.94,278.94,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,188.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,200.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,107,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,192.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,107,448,,facility
DRAW BLOOD OFF VENOUS DEVICE,36591,CPT,761,RC,,,,outpatient,,,152.14,15.21,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,117.45,113.1,127.33,58,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,279.68,279.68,279.68,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,131.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,230.74,146.83,499.05,16,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,146.83,146.83,148.14,1 through 10,percent of total billed charges,,,34.6,,158.63,158.63,158.63,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,266.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,134.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,218.5,218.5,218.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,91.77,91.77,91.77,17,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,134.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,129.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,127.33,448,,facility
X-RAY EXAM OF JAW JOINT,70328,CPT,320,RC,,,,outpatient,,,108.23,10.82,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,85.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,174.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,84.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,83.29,448,,facility
NRV CNDJ TEST 13/> STUDIES,95913,CPT,922,RC,,,,outpatient,,,638.35,63.84,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,465.55,329.42,504.72,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,357.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,357.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,367.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,357.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,746.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,378.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,81.45,81.45,85.76,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,357.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,378.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,478,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,364.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,357.13,746.4,,facility
EXCIMER LSR PSRIASIS>500SQCM,96922,CPT,940,RC,,,,outpatient,,,474.9,47.49,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,400.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,813.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,412.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,412.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,418,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,396.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,389.05,1173,,facility
BDY SURF MAPG PM/CVDFB F/UP,0696T,CPT,730,RC,,,,outpatient,,,44.91,4.49,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,74.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,389,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,36.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.71,448,,facility
MITOCHONDRIAL ANTIBODY EACH,86381,CPT,302,RC,,,,outpatient,,,31.81,3.18,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,22.64,22.64,22.64,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,45.41,16.13,249.13,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,28.9,28.9,28.9,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,25.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,53.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,26.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,22.64,22.64,22.64,19,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,25.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,26.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,44.54,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,25.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,25.45,448,,facility
BLOOD FUNGUS CULTURE,87103,CPT,306,RC,,,,outpatient,,,25.58,2.56,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,20.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,42.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,21.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,20.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,21.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.81,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,20.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,20.46,448,,facility
HEARING LOSS DUP/DEL ANALYS,81431,CPT,310,RC,,,,outpatient,,,849.46,84.95,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,679.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,679.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,699.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,679.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1420.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,720.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,679.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,720.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1189.25,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,693.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1420.3,,facility
CLOT INHIBIT PROT C ACTIVITY,85303,CPT,305,RC,,,,outpatient,,,17.3,1.73,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.31,12.31,12.31,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,40.66,25.87,40.66,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,28.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.31,12.31,12.31,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.89,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.84,448,,facility
ASSAY OF ANDROSTERONE,82160,CPT,301,RC,,,,outpatient,,,31.94,3.19,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,22.73,22.73,22.73,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,25.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,53.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,27.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,25.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,27.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,54.02,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,26.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,25.55,448,,facility
HIV-1 AG W/HIV-1&-2 AB AG IA,87389,CPT,306,RC,,,,outpatient,,,30.1,3.01,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,21.42,21.42,21.42,263,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,35.4,35.4,35.4,16,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,31.68,20.16,31.68,80,percent of total billed charges,,,33.6,,20.34,20.16,31.68,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,20.16,20.16,20.34,158,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,24.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,50.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,25.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,30,30,30,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,21.42,21.42,21.42,1 through 10,percent of total billed charges,,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,21.42,21.42,21.42,533,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,24.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,25.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,52.03,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,24.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,24.08,448,,facility
HEMOGLOBIN GLYCOSYLATED A1C,83036,CPT,301,RC,,,,outpatient,,,12.14,1.21,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,8.64,8.64,8.64,577,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,34.22,33.93,128.62,24,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,30.62,19.49,115.1,181,percent of total billed charges,,,33.6,,19.49,19.49,73.25,32,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,19.49,19.49,19.49,332,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,9.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,20.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,29,28.75,29,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,12.18,12.08,45.78,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,8.64,8.64,8.64,1 through 10,percent of total billed charges,,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,8.64,8.64,8.64,1281,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,9.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.98,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,9.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,9.71,448,,facility
X-RAY EXAM OF SPINE 1 VIEW,72020,CPT,320,RC,,,,outpatient,,,108.23,10.82,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,85.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,174.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.47,13.47,13.47,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,84.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,83.29,448,,facility
OBINUTUZUMAB INJ,J9301,HCPCS,636,RC,,,,outpatient,,,92.69,9.27,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,84.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,84.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,86.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,84.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,176.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,89.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,84.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,89.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,160.88,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,86.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,84.46,448,,facility
PRGRMG EVAL IMPLANTABLE DFB,93283,CPT,480,RC,,,,outpatient,,,44.91,4.49,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,32.72,32.72,32.72,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,177.92,154.88,177.92,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,35.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,146.78,146.78,146.78,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,93.41,93.41,93.41,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,74.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,33.71,5.1,35.52,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1463,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,36.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.71,1463,,facility
HDR RDNCL NTRSTL/ICAV BRCHTX,77772,CPT,342,RC,,,,outpatient,,,853.91,85.39,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,666.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,666.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,686.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,666.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1393.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,706.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,666.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,706.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1945,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,679.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1945,,facility
BHV ID ASSMT BY PHYS/QHP,97151,CPT,918,RC,,,,outpatient,,,106.16,10.62,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,51.96,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,89.84,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,97.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,97.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,97.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,203.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,97.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1372,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,99.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,51.96,1372,,professional
INSERT TUN IP CATH PERC,49418,CPT,361,RC,,,,outpatient,,,4120.43,412.04,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,3426.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3426.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3529.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,5809.16,5809.16,5809.16,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3426.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,7161.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3632.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3426.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3632.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10137,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,3495.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,10137,,facility
SPECIAL RADIATION DOSIMETRY,77331,CPT,333,RC,,,,outpatient,,,161.6,16.16,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,128.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,128.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,132.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,128.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,268.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,136.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,128.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,136.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,48815,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,131.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,128.64,48815,,facility
CAT SCAN FOLLOW-UP STUDY,76380,CPT,350,RC,,,,outpatient,,,108.23,10.82,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,403,,,,,,,case rate,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,371,,,,,,,case rate,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,875,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1050,,,,,,,case rate,NTE Percentage + Reimbursement Rate 85.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,85.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,174.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1522,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,84.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,83.29,1522,,facility
INTMD RPR S/A/T/EXT 12.6-20,12035,CPT,761,RC,,,,outpatient,,,474.9,47.49,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,400.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,813.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,412.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,412.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,396.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,389.05,1311,,facility
TRIM NAIL(S) ANY NUMBER,11719,CPT,450,RC,,,,outpatient,,,72.85,7.29,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,56.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,56.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,58.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,56.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,118,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,59.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,56.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,59.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,57.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,56.46,448,,facility
US EXAM SCROTUM,76870,CPT,402,RC,,,,outpatient,,,130.94,13.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,1100.8,1100.8,1100.8,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,982.12,577.92,982.12,1 through 10,percent of total billed charges,,,33.6,,577.92,577.92,982.12,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,577.92,577.92,577.92,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,56.35,56.35,58.57,34,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,465,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,465,,facility
PNEUMOCYSTIS CARINII AG IF,87281,CPT,306,RC,,,,outpatient,,,14.98,1.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.66,10.66,10.66,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.9,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.98,448,,facility
TANGNTL BX SKIN SINGLE LES,11102,CPT,761,RC,,,,outpatient,,,238.44,23.84,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,174.34,174.34,389.05,28,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,400.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,813.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,412.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,412.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,396.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,389.05,1173,,facility
ASSAY ALKALINE PHOSPHATASES,84080,CPT,301,RC,,,,outpatient,,,18.48,1.85,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.15,13.15,13.15,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,12.43,12.43,12.43,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,12.43,12.43,12.54,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,30.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.15,13.15,13.15,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,31.94,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,15.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.78,448,,facility
IMMUNODIFFUSION NES,86329,CPT,302,RC,,,,outpatient,,,17.56,1.76,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,29.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.35,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.05,448,,facility
TREAT FOOT DISLOCATION,28545,CPT,450,RC,,,,outpatient,,,3855.04,385.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3131.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3131.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3225.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3131.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,6544.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3319.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3131.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3319.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3194.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,6544.81,,facility
UNLISTED PX SMALL INTESTINE,44799,CPT,750,RC,,,,outpatient,,,1079.61,107.96,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,868.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,868.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,894.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,868.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1814.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,920.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,868.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,920.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3821,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,885.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3821,,facility
INTMD RPR FACE/MM 12.6-20 CM,12055,CPT,761,RC,,,,outpatient,,,474.9,47.49,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,400.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,813.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,412.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,412.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,396.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,389.05,1311,,facility
PLACE GASTROSTOMY TUBE PERC,49440,CPT,361,RC,,,,outpatient,,,2266.24,226.62,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,1836.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1836.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1891.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1836.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3838.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1946.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1836.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1946.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3821,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1873.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3838.31,,facility
US EXAM OF HEAD AND NECK,76536,CPT,402,RC,,,,outpatient,,,130.94,13.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,961.92,961.92,961.92,15,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,886.77,886.77,886.77,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,793.58,505.01,793.58,15,percent of total billed charges,,,33.6,,505.01,505.01,505.01,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,505.01,505.01,509.52,24,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,751.5,751.5,751.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,315.63,315.63,315.63,1 through 10,percent of total billed charges,,,35,,144.08,144.08,144.08,1 through 10,percent of total billed charges,,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,66.88,66.88,69.96,27,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,465,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,465,,facility
LAPARO CHOLECYSTECTOMY/EXPLR,47564,CPT,360,RC,,,,outpatient,,,12259.7,1225.97,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2004,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,2759,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 6500.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,10173.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10173.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10478.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10173.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,21262.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10783.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10173.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10783.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11062,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,10376.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,21262.32,,facility
CYTP DX EVAL FNA 1ST EA SITE,88172,CPT,311,RC,,,,outpatient,,,203.43,20.34,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,150.35,150.35,163,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,316.8,316.8,316.8,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,167.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,261.36,166.32,522.72,1 through 10,percent of total billed charges,,,33.6,,166.32,166.32,166.32,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,166.32,166.32,167.81,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,340.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,172.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,17.79,17.79,17.79,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,172.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,226.07,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,166.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,163.06,448,,facility
NJX AA&/STRD VAGUS NRV,64408,CPT,450,RC,,,,outpatient,,,352.75,35.28,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,293.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,293.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,302.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,293.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,613.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,311.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,293.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,311.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,299.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,293.77,1173,,facility
CACNA1A GENE FULL GENE SEQ,81185,CPT,310,RC,,,,outpatient,,,1057.84,105.78,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,846.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,846.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,871.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,846.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1768.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,897.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,846.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,897.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1480.97,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,863.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1768.7,,facility
STREP A DNA AMP PROBE,87651,CPT,306,RC,,,,outpatient,,,43.86,4.39,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.22,31.21,31.22,264,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,86.79,51.07,86.79,133,percent of total billed charges,,,33.6,,51.07,51.07,86.79,32,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,51.07,39.66,51.07,30,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,76,58.5,76,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,290,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
REPAIR LAC PALATE<2 CM,42180,CPT,450,RC,,,,outpatient,,,655.29,65.53,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,516.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,516.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,531.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,516.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1078.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,547.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,516.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,547.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,526.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1173,,facility
OCCULT BLD FECES 1-3 TESTS,82272,CPT,301,RC,,,,outpatient,,,5.29,0.53,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.76,3.76,3.76,11,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,8.96,8.96,8.96,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,4.7,4.7,7.39,1 through 10,percent of total billed charges,,,33.6,,7.39,7.39,7.39,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,8.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,24,24,24,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.76,3.76,3.76,31,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.4,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,4.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,4.23,448,,facility
INS VAG BRACHYTX DEVICE,57156,CPT,361,RC,,,,outpatient,,,382.08,38.21,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,269.01,269.01,291.64,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,291.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,291.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,300.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,291.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,609.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,309.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,291.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,309.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2440,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,297.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,291.64,2440,,facility
DSTRJ MAL LES T/A/L .6-1.0CM,17261,CPT,761,RC,,,,outpatient,,,238.44,23.84,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,197.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,401.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,203.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,203.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,195.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,192.01,1173,,facility
CLTX ULNAR FX PROX W/MNPJ,24675,CPT,761,RC,,,,outpatient,,,1914.16,191.42,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1585.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3216.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1631.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1631.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,1569.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3216.38,,facility
ULTRASOUND BREAST LIMITED,76642,CPT,402,RC,,,,outpatient,,,108.23,10.82,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,85.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,174.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,42.34,42.34,44.13,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,465,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,84.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,83.29,465,,facility
DESTROY CERV/THOR FACET JNT,64633,CPT,361,RC,,,,outpatient,,,2299.54,229.95,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,1868.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1868.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1924.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1868.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3905.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1981,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1868.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1981,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9389,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1906.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,9389,,facility
ASSAY OF CHROMIUM,82495,CPT,301,RC,,,,outpatient,,,25.35,2.54,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,20.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,42.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,21.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,20.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,21.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,43.82,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,20.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,20.28,448,,facility
ASSAY LIPOPROTEIN PLA2,83698,CPT,301,RC,,,,outpatient,,,57.89,5.79,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,46.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,46.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,47.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,46.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,96.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,49.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,46.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,49.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,81.04,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,47.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,46.31,448,,facility
HIV-1 QUANT&REVRSE TRNSCRPJ,87536,CPT,306,RC,,,,outpatient,,,106.38,10.64,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,75.7,75.7,75.7,61,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,115.05,115.05,369.93,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,124.8,124.8,124.8,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,85.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,85.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,87.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,102.96,65.52,102.96,24,percent of total billed charges,,,33.6,,102.96,65.52,331.06,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,65.52,65.52,66.11,15,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,85.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,177.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,90.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,97.5,97.5,97.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,75.7,75.7,75.7,201,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,85.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,90.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,183.86,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,86.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,85.1,448,,facility
X-RAY EXAM OF WRIST,73100,CPT,320,RC,,,,outpatient,,,108.23,10.82,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,85.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,174.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,20.75,20.75,21.64,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,84.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,83.29,448,,facility
VEEG EA 12-26HR INTMT MNTR,95715,CPT,740,RC,,,,outpatient,,,638.35,63.84,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,357.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,357.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,367.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,357.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,746.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,378.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,357.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,378.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1175,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,364.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,357.13,1175,,facility
INJ IRINOTECAN LIPOSOME 1 MG,J9205,HCPCS,636,RC,,,,outpatient,,,79.22,7.92,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,65.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,65.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,67.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,65.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,137.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,69.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,65.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,69.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,138.07,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,67.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,65.86,448,,facility
TRACHEOSTOMA REVJ SIMPLE,31613,CPT,761,RC,,,,outpatient,,,3834.53,383.45,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3173.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3173.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3268.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3173.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,6631.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3363.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3173.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3363.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,3236.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,6631.76,,facility
ABL1 GENE,81170,CPT,310,RC,,,,outpatient,,,375,37.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,300,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,300,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,309,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,300,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,627,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,318,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,266.85,266.85,266.85,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,300,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,318,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,525,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,306,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,300,627,,facility
ASSAY OF TRANSFERRIN,84466,CPT,301,RC,,,,outpatient,,,15.95,1.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.35,11.35,11.35,19,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,63.57,63.57,63.57,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,57.02,36.29,217.54,41,percent of total billed charges,,,33.6,,36.29,36.29,217.54,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,36.53,36.29,138.43,42,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,26.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,54,53.88,54,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.35,11.35,11.35,63,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.58,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.76,448,,facility
RESP VIRUS 3-5 TARGETS,87631,CPT,306,RC,,,,outpatient,,,178.29,17.83,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,126.87,126.87,126.87,66,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,142.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,142.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,146.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,71.53,71.53,138.75,1 through 10,percent of total billed charges,,,33.6,,71.53,71.53,71.53,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,142.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,298.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,151.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,126.87,126.87,126.87,143,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,142.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,151.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,277.17,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,145.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,142.63,448,,facility
TREAT THIGH FX GROWTH PLATE,27517,CPT,761,RC,,,,outpatient,,,1914.16,191.42,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1585.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3216.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1631.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1631.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,1569.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3216.38,,facility
LIPID PANEL,80061,CPT,301,RC,,,,outpatient,,,16.74,1.67,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.91,11.91,11.91,1021,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,34.81,34.81,34.81,26,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,37.76,37.76,37.76,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,31.15,19.82,31.15,172,percent of total billed charges,,,33.6,,20,19.82,31.15,37,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,19.82,19.82,20,389,percent of total billed charges,,,34.6,,21.83,21.83,21.83,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,29.5,29.5,123.5,11,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,12.39,12.39,51.87,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.91,11.91,11.91,1133,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.93,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.39,448,,facility
TISSUE CULTURE SKIN/BIOPSY,88233,CPT,311,RC,,,,outpatient,,,175.91,17.59,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,125.18,125.18,125.18,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,140.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,140.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,144.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,140.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,294.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,149.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,140.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,149.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,304.05,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,143.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,140.73,448,,facility
COLONOSCOPY SUBMUCOUS NJX,45381,CPT,750,RC,,,,outpatient,,,1405.45,140.55,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,1034.53,1034.53,1034.53,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1179.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,2393.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1213.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1213.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3821,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1168.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3821,,facility
MLH1 GENE,81288,CPT,310,RC,,,,outpatient,,,240.4,24.04,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,192.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,192.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,198.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,192.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,401.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,203.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,192.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,203.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,336.56,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,196.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,192.32,448,,facility
NJX INTERLAMINAR CRV/THRC,62321,CPT,361,RC,,,,outpatient,,,823.63,82.36,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,675.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,675.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,695.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,675.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1411.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,716.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,635.65,635.65,635.65,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,675.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,716.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2712,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,689.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,2712,,facility
ECHO EXAMINATION PROCEDURE,76999,CPT,400,RC,,,,outpatient,,,108.23,10.82,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,235.52,235.52,235.52,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,85.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,174.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,197,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,84.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,83.29,448,,facility
STRAPPING ANKLE &/FOOT,29540,CPT,761,RC,,,,outpatient,,,187.66,18.77,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,155.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,155.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,160.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,155.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,325.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,164.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,155.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,164.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,158.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,155.52,448,,facility
ORGANIC ACID SINGLE QUANT,83921,CPT,301,RC,,,,outpatient,,,26.51,2.65,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,18.87,18.87,18.87,11,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,60.72,38.64,203.28,1 through 10,percent of total billed charges,,,33.6,,129.36,129.36,129.36,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,38.64,38.64,38.9,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,21.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,44.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,57.38,57.38,57.38,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,18.87,18.87,18.87,21,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,21.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,37.12,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,21.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,21.21,448,,facility
RBC SED RATE AUTOMATED,85652,CPT,305,RC,,,,outpatient,,,3.38,0.34,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,2.4,2.4,2.4,155,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,12.8,12.8,12.8,42,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,11.8,11.8,11.8,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,10.56,6.72,147.32,64,percent of total billed charges,,,33.6,,10.56,6.72,86.69,12,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,6.78,6.72,86.69,51,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,5.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,10,10,129,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,4.2,4.2,4.2,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,2.4,2.4,2.4,674,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,2.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,2.7,448,,facility
X-RAY EXAM OF SKULL,70250,CPT,320,RC,,,,outpatient,,,130.94,13.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,625.99,625.99,625.99,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,356.5,356.5,560.21,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,530.5,530.5,530.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,22.1,22.1,22.75,27,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,448,,facility
HL NEO GSAP 5-50 RNA ALYS,81451,CPT,310,RC,,,,outpatient,,,949.41,94.94,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,759.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,759.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,782.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,759.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1587.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,805.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,759.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,805.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1329.18,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,774.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1587.42,,facility
WHOLE MITOCHONDRIAL GENOME,81460,CPT,310,RC,,,,outpatient,,,1608.75,160.88,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1287,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1287,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1325.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1287,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,2689.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1364.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1287,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1364.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2252.25,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1312.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,2689.83,,facility
ASSAY OF VANCOMYCIN,80202,CPT,301,RC,,,,outpatient,,,16.93,1.69,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,28.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.04,12.04,12.04,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.26,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.54,448,,facility
TREAT HIP DISLOCATION,27266,CPT,450,RC,,,,outpatient,,,1914.16,191.42,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1585.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3216.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1631.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1631.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1569.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3216.38,,facility
ASSAY GALACTOSE TRANSFERASE,82775,CPT,301,RC,,,,outpatient,,,26.34,2.63,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,21.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,44.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,21.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,45.52,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,21.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,21.07,448,,facility
LAP JEJUNOSTOMY,44186,CPT,761,RC,,,,outpatient,,,6871.99,687.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1445,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,2070,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5785.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5785.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5959.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5785.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,12092.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6133.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5785.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6133.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,5901.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,12092.57,,facility
SMALL BOWEL ENDOSCOPY,44360,CPT,750,RC,,,,outpatient,,,2266.24,226.62,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,1664.42,1664.42,1664.42,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,1836.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1836.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1891.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1836.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3838.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1946.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1836.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1946.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3821,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1873.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3838.31,,facility
REPAIR MOUTH LACERATION,40831,CPT,450,RC,,,,outpatient,,,655.29,65.53,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,516.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,516.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,531.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,516.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1078.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,547.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,453.49,453.49,453.49,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,516.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,547.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,526.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1173,,facility
US EXAM ABDOM COMPLETE,76700,CPT,402,RC,,,,outpatient,,,130.94,13.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,93.3,93.3,268.93,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,1620.48,1620.48,1620.48,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,1336.9,850.75,1336.9,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,850.75,850.75,850.75,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,1266,1266,1266,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,62.56,62.56,62.56,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,465,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,465,,facility
DRAINAGE OF MOUTH LESION,40800,CPT,761,RC,,,,outpatient,,,837.95,83.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,677.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,677.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,698.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,677.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1416.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,718.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,677.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,718.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,691.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1416.43,,facility
ECHO EXAM OF FETAL HEART,76826,CPT,402,RC,,,,outpatient,,,291.84,29.18,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,212.09,212.09,212.09,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,1745.28,1745.28,1745.28,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,235.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,1439.86,1439.86,1439.86,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,477.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,242.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,93.05,93.05,93.05,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,242.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,465,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,232.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,228.36,477.27,,facility
X-RAY EXAM ENTIRE SPI 4/5 VW,72083,CPT,320,RC,,,,outpatient,,,130.94,13.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,1037.44,1037.44,1037.44,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,448,,facility
APHERESIS PLATELETS,36513,CPT,940,RC,,,,outpatient,,,517.01,51.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,422.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,422.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,434.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,422.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,882.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,447.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,422.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,447.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,418,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,430.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,418,1311,,facility
CT ORBIT/EAR/FOSSA W/O&W/DYE,70482,CPT,351,RC,,,,outpatient,,,218.83,21.88,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,403,,,,,,,case rate,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,371,,,,,,,case rate,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,875,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1050,,,,,,,case rate,NTE Percentage + Reimbursement Rate 85.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,172.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,350.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,177.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,177.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1522,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,171.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,167.87,1522,,facility
VENT MGMT INPAT INIT DAY,94002,CPT,410,RC,,,,inpatient,,,746.35,74.64,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Short Stay Lesser of + Days Threshold 1.00 + Stoploss First Dollar + Reimbursement Rate 57.00 + Basic Per Diem + Fixed Rate 5000.00 + Fixed Amount 157464.00,,,,0,other,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,Short Stay Lesser of + Days Threshold 1.00 + Stoploss First Dollar + Reimbursement Rate 72.00 + Basic Per Diem + Fixed Rate 10000.00 + Fixed Amount 56687.00,,,,0,other,NTE Percentage + Reimbursement Rate 85.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,47.3,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,facility
UNLISTED PX DENTALVLR STRUX,41899,CPT,450,RC,,,,outpatient,,,290.91,29.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,209.09,203.75,226.68,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,226.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,226.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,233.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,226.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,473.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,240.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,226.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,240.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,231.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,226.68,1173,,facility
X-RAY STRENOCLAVIC JT 3/>VWS,71130,CPT,320,RC,,,,outpatient,,,108.23,10.82,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,85.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,174.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,84.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,83.29,448,,facility
"INJ., CEMIPLIMAB-RWLC, 1 MG",J9119,HCPCS,636,RC,,,,outpatient,,,34.62,3.46,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,29.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,,,0,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00 + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,62.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,0,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00 + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,29.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,31.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,60.65,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,30.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,29.67,448,,facility
"INJ. LURBINECTEDIN, 0.1 MG",J9223,HCPCS,636,RC,,,,outpatient,,,253.45,25.35,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,215.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,215.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,222.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,215.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,451.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,228.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,215.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,228.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,440.54,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,220.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,215.95,451.34,,facility
EEG CONT REC W/VID EEG TECH,95700,CPT,740,RC,,,,outpatient,,,186.04,18.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,137.28,137.28,206.65,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,206.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,206.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,212.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,529.58,337.01,529.58,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,206.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,431.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,219.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,242.61,242.61,242.61,18,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,206.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,219.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1175,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,210.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,206.65,1175,,facility
SNRPN/UBE3A GENE,81331,CPT,310,RC,,,,outpatient,,,63.84,6.38,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,45.43,45.43,45.43,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,51.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,51.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,52.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,51.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,106.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,54.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,51.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,54.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,89.37,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,52.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,51.07,448,,facility
DILATION OF CERVICAL CANAL,57800,CPT,761,RC,,,,outpatient,,,3723.46,372.35,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3098.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3098.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3191.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3098.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,6475.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3284,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3098.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3284,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,3160.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,6475.05,,facility
DRESS/DEBRID P-THICK BURN L,16030,CPT,761,RC,,,,outpatient,,,474.9,47.49,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,400.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,813.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,412.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,412.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,396.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,389.05,1311,,facility
SPECIAL RADIATION TREATMENT,77470,CPT,333,RC,,,,outpatient,,,701.09,70.11,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,528.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,528.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,544.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,528.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1105.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,560.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,528.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,560.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,48815,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,539.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,48815,,facility
STR MARKERS SPEC ANAL ADDL,81266,CPT,310,RC,,,,outpatient,,,381.01,38.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,304.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,304.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,313.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,304.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,637.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,323.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,304.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,323.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,533.42,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,310.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,304.81,637.05,,facility
REPAIR EYELID WOUND,67930,CPT,361,RC,,,,outpatient,,,2783.1,278.31,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,2275.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2275.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2343.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2275.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,4755.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2411.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2275.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2411.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9389,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,2320.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,9389,,facility
DBRDMT MUSC&/FSCA 1ST 20/<,11043,CPT,761,RC,,,,outpatient,,,748,74.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,707.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,707.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,728.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,707.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1478.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,749.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,707.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,749.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,721.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1478.34,,facility
THROMBLYTIC ART/VEN THERAPY,37213,CPT,320,RC,,,,outpatient,,,3796.26,379.63,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1027,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1519,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3021.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3021.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3112.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3021.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,6315.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3203.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3021.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3203.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,3082.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,443,6315.75,,facility
TREAT KNEECAP FRACTURE,27520,CPT,450,RC,,,,outpatient,,,280.86,28.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,243.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,493.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,240.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,236.08,1173,,facility
T-CELL DEPLETION OF HARVEST,38210,CPT,815,RC,,,,inpatient,,,517.01,51.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Short Stay Lesser of + Days Threshold 1.00 + Stoploss First Dollar + Reimbursement Rate 57.00 + Basic Per Diem + Fixed Rate 5000.00 + Fixed Amount 157464.00,,,,0,other,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,Short Stay Lesser of + Days Threshold 1.00 + Stoploss First Dollar + Reimbursement Rate 72.00 + Basic Per Diem + Fixed Rate 10000.00 + Fixed Amount 56687.00,,,,0,other,NTE Percentage + Reimbursement Rate 85.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,47.3,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,facility
ASSAY OF CREATININE,82565,CPT,301,RC,,,,outpatient,,,6.4,0.64,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.55,4.55,4.55,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,34.22,10.24,34.22,11,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,30.62,19.49,61.25,61,percent of total billed charges,,,33.6,,19.49,19.49,38.98,20,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,19.49,19.49,38.98,55,percent of total billed charges,,,34.6,,30.62,30.62,30.62,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,10.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,29,29,29,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,12.18,12.18,12.18,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.55,4.55,4.55,281,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.08,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.12,448,,facility
COLONOSCOPY W/ENDOSCOPE US,45391,CPT,750,RC,,,,outpatient,,,1405.45,140.55,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1179.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,2393.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1213.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1213.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3821,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1168.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3821,,facility
REMOVE EXTERNAL EAR PARTIAL,69110,CPT,761,RC,,,,outpatient,,,3384.19,338.42,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2779.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2779.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2863.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2779.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,5810.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2946.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2779.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2946.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,2835.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,5810.16,,facility
ASPA GENE,81200,CPT,310,RC,,,,outpatient,,,59.06,5.91,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,47.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,47.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,48.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,47.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,98.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,50.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,47.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,50.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,82.69,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,48.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,47.25,448,,facility
R HRT ART/GRFT ANGIO,93457,CPT,480,RC,,,,outpatient,,,3880.91,388.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2004,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,2759,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,3102.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3102.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3195.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3102.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,6484.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3288.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3102.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3288.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1463,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,3164.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,1463,6484.66,,facility
SMALL BOWEL ENDOSCOPY,44373,CPT,750,RC,,,,outpatient,,,2266.24,226.62,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,1836.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1836.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1891.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1836.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3838.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1946.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1836.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1946.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3821,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1873.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3838.31,,facility
REMOVE PHARYNX FOREIGN BODY,42809,CPT,761,RC,,,,outpatient,,,474.54,47.45,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,427.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,427.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,440.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,427.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,893.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,453.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,427.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,453.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,436.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,427.54,1173,,facility
HTT GENE DETC ABNOR ALLELES,81271,CPT,310,RC,,,,outpatient,,,171.25,17.13,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,137,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,137,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,141.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,137,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,286.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,145.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,137,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,145.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,239.75,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,139.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,137,448,,facility
EXCISE ANAL EXT TAG/PAPILLA,46220,CPT,761,RC,,,,outpatient,,,1405.45,140.55,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1179.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,2393.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1213.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1213.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,1168.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,2393.57,,facility
CACNA1A GEN KNOWN FAMIL VRNT,81186,CPT,310,RC,,,,outpatient,,,231.5,23.15,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,185.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,185.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,190.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,185.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,387.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,196.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,185.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,196.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,324.1,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,188.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,185.2,448,,facility
EXTRACTION,10040,CPT,761,RC,,,,outpatient,,,238.44,23.84,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,197.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,401.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,203.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,176.95,176.95,176.95,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,203.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,195.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,192.01,448,,facility
TREATMENT OF TIBIA FRACTURE,27752,CPT,761,RC,,,,outpatient,,,1914.16,191.42,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1585.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3216.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1631.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1631.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,1569.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3216.38,,facility
DILATE URETHRA STRICTURE,53605,CPT,761,RC,,,,outpatient,,,4151.98,415.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3373.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3373.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3474.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3373.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,7050.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3576.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3373.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3576.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,3441.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,7050.84,,facility
INTMD RPR FACE/MM 2.5 CM/<,12051,CPT,761,RC,,,,outpatient,,,474.9,47.49,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,175.27,164.09,177.9,11,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,400.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,813.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,412.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,355.79,183.04,355.79,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,412.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,396.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,389.05,1173,,facility
GASTRIC MOTILITY STUDIES,91020,CPT,750,RC,,,,outpatient,,,638.35,63.84,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,357.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,357.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,367.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,357.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,746.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,378.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,357.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,378.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2440,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,364.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,357.13,2440,,facility
ASPIRATE PLEURA W/ IMAGING,32555,CPT,761,RC,,,,outpatient,,,748.19,74.82,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,600.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,600.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,618.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,1700.16,1700.16,1700.16,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,600.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1254.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,636.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,600.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,636.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,612.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1254.75,,facility
ASSAY OF URINE PORPHYRINS,84120,CPT,301,RC,,,,outpatient,,,18.39,1.84,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,62.3,62.3,62.3,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,30.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,31.78,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.71,448,,facility
BL SMEAR W/DIFF WBC COUNT,85007,CPT,305,RC,,,,outpatient,,,4.75,0.48,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.38,3.38,3.38,135,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,407.04,8.32,467.84,76,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,7.67,7.67,431.29,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,385.97,6.86,417.4,56,percent of total billed charges,,,33.6,,245.62,245.62,245.62,33,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,242.32,4.37,245.62,60,percent of total billed charges,,,34.6,,265.35,265.35,265.35,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,7.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,6.5,3.38,365.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,153.51,153.51,153.51,1 through 10,percent of total billed charges,,,35,,318,318,318,1 through 10,percent of total billed charges,,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.38,3.38,3.38,861,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.42,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,3.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,3.8,448,,facility
THER RAD SIMULAJ FIELD CPLX,77290,CPT,333,RC,,,,outpatient,,,440.06,44.01,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,2602.24,487.49,2602.24,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,358.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,358.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,369.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,1366.18,1366.18,1366.18,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,1366.18,1366.18,1378.37,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,358.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,748.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,379.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,2033,2033,2033,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,358.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,379.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,48815,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,365.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,358.36,48815,,facility
NTRK2 TRANSLOCATION ANALYSIS,81192,CPT,310,RC,,,,outpatient,,,259.14,25.91,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,207.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,207.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,213.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,207.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,433.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,219.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,207.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,219.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,362.79,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,211.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,207.31,448,,facility
INJ W/FLUOR EVAL CV DEVICE,36598,CPT,361,RC,,,,outpatient,,,255.28,25.53,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,187.77,187.77,187.77,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,203.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,203.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,209.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,404.54,404.54,404.54,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,203.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,425.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,215.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,203.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,215.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2440,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,207.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,203.57,2440,,facility
TX TARSAL B1 FX W/O MNPJ EA,28450,CPT,450,RC,,,,outpatient,,,280.86,28.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,243.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,493.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,240.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,236.08,1173,,facility
LEGIONELLA ANTIBODY,86713,CPT,302,RC,,,,outpatient,,,19.13,1.91,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,31.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,33.06,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,15.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,15.3,448,,facility
ALPHA-FETOPROTEIN AMNIOTIC,82106,CPT,301,RC,,,,outpatient,,,21.25,2.13,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,35.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,212.79,212.79,212.79,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.24,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17,448,,facility
INJ FAM-TRASTU DERU-NXKI 1MG,J9358,HCPCS,636,RC,,,,outpatient,,,34.69,3.47,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,32.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,33.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,18458.88,15458.11,23955.92,3171,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,19338.96,11593.8,19338.96,2580,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,32.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,68.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,34.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,32.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,34.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,61.94,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,33.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,32.87,448,,facility
SC STD ENZYME DETCJ PER NZM,87185,CPT,306,RC,,,,outpatient,,,5.94,0.59,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.23,4.23,4.23,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,9.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.23,4.23,4.23,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.26,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,4.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,4.75,448,,facility
RF ABLTJ NRV NRVTG SI JT,64625,CPT,361,RC,,,,outpatient,,,2299.54,229.95,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1268,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1793,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,1868.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1868.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1924.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1868.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3905.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1981,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1868.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1981,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9389,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1906.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,9389,,facility
NPM1 GENE,81310,CPT,310,RC,,,,outpatient,,,308.15,30.82,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,219.28,219.28,219.28,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,246.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,246.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,253.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,246.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,515.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,261.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,246.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,261.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,431.41,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,251.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,246.52,515.23,,facility
SIGMOIDOSCOPY W/TUMR REMOVE,45338,CPT,750,RC,,,,outpatient,,,1405.45,140.55,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,1034.53,1034.53,1034.53,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1179.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,2393.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1213.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1213.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3821,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1168.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3821,,facility
"INJ, ATEZOLIZUMAB,10 MG",J9022,HCPCS,636,RC,,,,outpatient,,,107.22,10.72,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,96.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,96.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,99.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,96.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,201.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,102.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,96.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,102.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,189.67,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,98.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,96.55,448,,facility
CLTX MNDBLR/MAX ALV RIDGE FX,21440,CPT,761,RC,,,,outpatient,,,3834.53,383.45,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1027,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1519,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3173.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3173.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3268.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3173.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,6631.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3363.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3173.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3363.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,3236.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,6631.76,,facility
CHROMOSOME ANALYSIS 20-25,88264,CPT,311,RC,,,,outpatient,,,180.76,18.08,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,144.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,144.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,148.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,144.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,302.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,153.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,144.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,153.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,269.29,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,147.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,144.61,448,,facility
US URINE CAPACITY MEASURE,51798,CPT,761,RC,,,,outpatient,,,72.85,7.29,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,56.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,56.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,58.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,56.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,118,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,59.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,56.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,59.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,57.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,56.46,448,,facility
CYP2D6 GENE COM VARIANTS,81226,CPT,310,RC,,,,outpatient,,,563.64,56.36,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,450.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,450.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,464.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,450.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,942.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,477.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,450.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,477.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,789.09,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,459.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,942.4,,facility
TREAT HIP SOCKET FRACTURE,27220,CPT,761,RC,,,,outpatient,,,280.86,28.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,243.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,493.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,240.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,236.08,493.41,,facility
PLETHYSMOGRAPHY LUNG VOLUMES,94726,CPT,460,RC,,,,outpatient,,,373.83,37.38,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,329.42,273.22,357.13,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,538.24,49.05,538.24,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,357.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,357.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,367.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,444.05,282.58,444.05,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,282.58,282.58,282.58,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,357.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,746.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,378.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,176.61,176.61,176.61,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,36.38,36.38,36.89,40,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,357.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,378.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,611,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,364.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,357.13,746.4,,facility
ASSAY OF SERUM ALBUMIN,82040,CPT,301,RC,,,,outpatient,,,6.19,0.62,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.4,4.4,4.4,46,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,14.75,9.9,14.75,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,85,85,85,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,48.53,13.2,48.54,74,percent of total billed charges,,,33.6,,28.56,8.4,48.53,18,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,28.56,8.4,28.82,49,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,10.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,42.5,12.5,42.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,5.25,5.25,5.25,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.4,4.4,4.4,515,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.69,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,4.95,448,,facility
FLT3 GENE,81245,CPT,310,RC,,,,outpatient,,,206.89,20.69,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,165.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,165.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,170.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,165.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,345.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,175.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,165.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,175.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,289.64,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,168.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,165.51,448,,facility
NRV CNDJ TEST 7-8 STUDIES,95910,CPT,922,RC,,,,outpatient,,,373.83,37.38,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,273.22,273.22,357.13,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,357.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,357.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,367.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,357.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,746.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,378.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,56.64,56.64,56.64,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,357.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,378.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,478,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,364.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,357.13,746.4,,facility
RPR LIP FTH<HALF VER HEIGHT,40652,CPT,761,RC,,,,outpatient,,,655.29,65.53,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1027,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1519,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,516.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,516.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,531.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,516.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1078.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,547.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,516.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,547.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,526.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1519,,facility
SHAVE SKIN LESION 1.1-2.0 CM,11307,CPT,761,RC,,,,outpatient,,,238.44,23.84,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,197.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,401.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,203.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,203.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,195.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,192.01,448,,facility
X-RAY EXAM NECK SPINE 4/5VWS,72050,CPT,320,RC,,,,outpatient,,,130.94,13.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,1036.16,1036.16,1036.16,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,854.83,854.83,854.83,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,543.98,543.98,543.98,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,448,,facility
"DARATUMUMAB, HYALURONIDASE",J9144,HCPCS,636,RC,,,,outpatient,,,63.75,6.38,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,57.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,57.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,58.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,16441.92,16441.92,16441.92,2160,percent of total billed charges,,,33.6,,16441.92,16441.92,16441.92,180,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,57.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,119.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,60.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,57.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,60.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,110.49,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,58.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,57.05,448,,facility
REMOVE IMPACTED EAR WAX UNI,69209,CPT,761,RC,,,,outpatient,,,72.85,7.29,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,56.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,56.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,58.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,56.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,118,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,59.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,56.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,59.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,57.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,56.46,1173,,facility
ASSAY OF NATRIURETIC PEPTIDE,83880,CPT,301,RC,,,,outpatient,,,49.08,4.91,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,34.92,34.92,34.92,37,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,39.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,39.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,40.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,261.74,127.51,444.81,39,percent of total billed charges,,,33.6,,261.74,261.74,444.81,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,81.87,81.31,261.74,29,percent of total billed charges,,,34.6,,89.35,89.35,89.35,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,39.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,82.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,41.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,389.5,389.5,389.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,34.92,34.92,34.92,366,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,39.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,41.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,73.33,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,40.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,39.26,448,,facility
MRI BREAST C- BILATERAL,77047,CPT,610,RC,,,,outpatient,,,291.84,29.18,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1025,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1350,,,,,,,case rate,NTE Percentage + Reimbursement Rate 85.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,235.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,477.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,242.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,242.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2407,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,232.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,228.36,2407,,facility
DRUG ASSAY CLOZAPINE,80159,CPT,301,RC,,,,outpatient,,,25.19,2.52,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,20.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,42.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,21.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,20.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,21.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,39.95,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,20.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,20.15,448,,facility
RBC SERUM PRETX ID DILUTION,86976,CPT,302,RC,,,,outpatient,,,35.46,3.55,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,27.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,57.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,29.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,27.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,29.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.57,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,28.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,27.68,448,,facility
REMOVAL SUTR/STAPLE REQ ANES,15851,CPT,761,RC,,,,outpatient,,,2171.91,217.19,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1974.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1974.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2033.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1974.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,4127.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2093.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1974.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2093.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,2014.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,4127.08,,facility
DPYD GENE COMMON VARIANTS,81232,CPT,310,RC,,,,outpatient,,,218.51,21.85,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,174.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,174.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,180.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,174.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,365.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,185.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,174.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,185.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,305.92,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,178.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,174.81,448,,facility
IMMUNOASSAY TUMOR CA 15-3,86300,CPT,302,RC,,,,outpatient,,,26.01,2.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,204.29,204.29,204.29,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,20.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,43.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,18.51,18.51,18.51,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,20.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,44.98,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,21.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,20.81,448,,facility
TREATMENT OF THIGH FRACTURE,27508,CPT,450,RC,,,,outpatient,,,280.86,28.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,243.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,493.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,240.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,236.08,1173,,facility
HEP C AB TEST CONFIRM,86804,CPT,302,RC,,,,outpatient,,,19.36,1.94,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,32.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,33.48,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,15.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,15.49,448,,facility
TREAT KNEE DISLOCATION,27552,CPT,761,RC,,,,outpatient,,,1914.16,191.42,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1585.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3216.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1631.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1631.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,1569.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3216.38,,facility
CLTX LUNATE DISLC W/MNPJ,25690,CPT,450,RC,,,,outpatient,,,1914.16,191.42,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1585.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3216.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1631.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1631.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1569.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3216.38,,facility
ALYS NPGT W/O PRGRMG,95970,CPT,920,RC,,,,outpatient,,,152.14,15.21,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,131.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,266.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,134.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.11,16.11,16.11,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,134.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,422,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,129.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,127.33,448,,facility
EEG MONITORING/FUNCTION TEST,95958,CPT,740,RC,,,,outpatient,,,1245.23,124.52,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,821.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,821.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,846.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,821.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1717.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,871.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,821.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,871.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1175,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,838.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1717.69,,facility
DRUGS UNCLASSIFIED INJECTION,J3490,HCPCS,636,RC,,,,outpatient,,,4,0.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,2.56,2.56,292.8,17,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,52.8,,6,2.11,205.42,49,percent of total billed charges,,,33.6,,6.72,0.67,163.37,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,5.29,0.84,200.34,25,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,50,,1,1,9.13,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,7.61,7.61,7.61,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",448,448,,facility
HEPATITIS A IGM ANTIBODY,86709,CPT,302,RC,,,,outpatient,,,14.08,1.41,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.02,10.02,10.02,22,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,76.16,76.16,76.16,19,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,70.21,70.21,70.21,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,62.83,62.83,62.83,1 through 10,percent of total billed charges,,,33.6,,39.98,39.98,62.83,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,39.98,39.98,40.34,13,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,23.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,59.5,59.5,59.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.02,10.02,10.02,66,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.33,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,11.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.26,448,,facility
ASSAY TRIIODOTHYRONINE (T3),84480,CPT,301,RC,,,,outpatient,,,17.73,1.77,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.61,12.61,12.61,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,19.85,19.85,19.85,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,12.77,12.77,71.23,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,19.26,12.77,71.23,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,29.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.61,12.61,12.61,15,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.64,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.18,448,,facility
SHAVE SKIN LESION 0.6-1.0 CM,11301,CPT,761,RC,,,,outpatient,,,238.44,23.84,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,197.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,401.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,203.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,203.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,195.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,192.01,448,,facility
QUAN MR TIS WO MRI 1ORGN,0648T,CPT,610,RC,,,,outpatient,,,1188.13,118.81,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1025,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1350,,,,,,,case rate,NTE Percentage + Reimbursement Rate 85.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,894.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,894.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,921.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,894.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1870.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,948.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,894.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,948.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2407,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,912.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,2407,,facility
SMN1 GEN NOWN FAMIL SEQ VRNT,81337,CPT,310,RC,,,,outpatient,,,231.5,23.15,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,185.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,185.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,190.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,185.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,387.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,196.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,185.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,196.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,324.1,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,188.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,185.2,448,,facility
DRUG SCREEN QUANT ZONISAMIDE,80203,CPT,301,RC,,,,outpatient,,,16.56,1.66,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.79,11.79,11.79,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.63,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.25,448,,facility
EXCIMER LSR PSRIASIS 250-500,96921,CPT,940,RC,,,,outpatient,,,238.44,23.84,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,197.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,401.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,203.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,203.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,418,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,195.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,192.01,1173,,facility
G-ESOPH REFLX TST W/ELECTROD,91035,CPT,750,RC,,,,outpatient,,,638.35,63.84,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,758.08,758.08,821.86,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,821.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,821.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,846.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,821.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1717.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,871.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,821.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,871.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2440,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,838.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,2440,,facility
TREAT FINGER FRACTURE EACH,26740,CPT,761,RC,,,,outpatient,,,280.86,28.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,243.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,493.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,240.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,236.08,1173,,facility
MUCOPOLYSACCHARIDES,83864,CPT,301,RC,,,,outpatient,,,35.63,3.56,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,25.35,25.35,25.35,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,54.38,54.38,54.38,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,28.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,59.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,30.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,28.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,30.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,49.88,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,29.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,28.5,448,,facility
X-RAY EXAM OF TOE(S),73660,CPT,320,RC,,,,outpatient,,,108.23,10.82,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,85.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,174.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,18.33,18.33,19.14,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,84.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,83.29,448,,facility
DBRDMT SUBQ TIS 1ST 20SQCM/<,11042,CPT,761,RC,,,,outpatient,,,474.9,47.49,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,400.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,813.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,412.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,412.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,396.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,389.05,1311,,facility
OB US FOLLOW-UP PER FETUS,76816,CPT,402,RC,,,,outpatient,,,130.94,13.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,58.29,58.29,58.29,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,465,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,465,,facility
SIGMOIDOSCOPY W/ULTRASOUND,45341,CPT,750,RC,,,,outpatient,,,1088.51,108.85,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,890.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,890.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,916.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,890.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1860.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,943.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,890.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,943.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3821,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,907.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3821,,facility
REMOVE RECTAL OBSTRUCTION,45915,CPT,450,RC,,,,outpatient,,,1405.45,140.55,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1179.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,2393.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1213.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1213.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1168.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,2393.57,,facility
NRV CNDJ TEST 11-12 STUDIES,95912,CPT,922,RC,,,,outpatient,,,638.35,63.84,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,357.13,329.42,504.72,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,357.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,357.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,367.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,357.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,746.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,378.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,71.19,71.19,77.43,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,357.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,378.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,478,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,364.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,357.13,746.4,,facility
RADIATION TREATMENT AID(S),77333,CPT,333,RC,,,,outpatient,,,161.6,16.16,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,128.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,128.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,132.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,128.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,268.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,136.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,128.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,136.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,48815,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,131.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,128.64,48815,,facility
REPAIR TONGUE LACERATION,41251,CPT,761,RC,,,,outpatient,,,290.91,29.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,226.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,226.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,233.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,226.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,473.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,240.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,226.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,240.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,231.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,226.68,1311,,facility
ACOUSTIC IMMITANCE TESTING,92570,CPT,471,RC,,,,outpatient,,,186.04,18.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,123.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,123.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,126.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,123.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,257.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,130.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,123.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,130.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,425,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,125.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,123.14,448,,facility
BILIARY ENDOSCOPY THRU SKIN,47554,CPT,361,RC,,,,outpatient,,,12259.7,1225.97,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1027,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1519,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 6500.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,10173.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10173.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10478.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10173.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,21262.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10783.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10173.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10783.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11062,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,10376.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,21262.32,,facility
ECOG IMPLTD BRN NPGT <30 D,95836,CPT,740,RC,,,,outpatient,,,44.91,4.49,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,74.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,91.16,91.16,93.26,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1175,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,36.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.71,1175,,facility
"INJ, LANREOTIDE, (CIPLA) 1MG",J1932,HCPCS,636,RC,,,,outpatient,,,208,20.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,20.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,20.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,42.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,21.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,20.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,21.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,65.96,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,20.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,20.33,448,,facility
RPR LIP FTH VERMILION ONLY,40650,CPT,761,RC,,,,outpatient,,,655.29,65.53,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1027,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1519,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,516.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,516.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,531.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,516.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1078.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,547.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,516.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,547.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,526.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1519,,facility
US EXAM SPINAL CANAL,76800,CPT,402,RC,,,,outpatient,,,130.94,13.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,1502.08,1306.24,1502.08,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,1384.73,1384.73,1384.73,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,1239.22,788.59,1239.22,1 through 10,percent of total billed charges,,,33.6,,788.59,788.59,788.59,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,788.59,788.59,788.59,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,465,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,465,,facility
BIOPSY OF NECK/CHEST,21550,CPT,361,RC,,,,outpatient,,,1930.94,193.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1628.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3303.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1675.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1675.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3821,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1612.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3821,,facility
INJECT SKIN LESIONS </W 7,11900,CPT,761,RC,,,,outpatient,,,238.44,23.84,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,174.34,174.34,180.67,25,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,197.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,401.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,203.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,176.95,176.95,176.95,40,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,203.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,1031.25,1031.25,1031.25,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,195.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,192.01,1173,,facility
MECP2 GENE KNOWN VARIANT,81303,CPT,310,RC,,,,outpatient,,,150,15,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,120,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,120,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,123.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,120,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,250.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,127.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,120,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,127.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,210,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,122.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,120,448,,facility
US ABDL AORTA SCREEN AAA,76706,CPT,402,RC,,,,outpatient,,,130.94,13.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,465,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,465,,facility
PMS2 GENE FULL SEQ ANALYSIS,81317,CPT,310,RC,,,,outpatient,,,845.63,84.56,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,676.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,676.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,696.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,676.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1413.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,717.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,676.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,717.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1237.29,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,690.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1413.88,,facility
US EXAM ABDO BACK WALL COMP,76770,CPT,402,RC,,,,outpatient,,,130.94,13.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,93.3,92.3,259.71,74,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,1287.68,1287.68,1287.68,44,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,1187.08,1187.08,1187.08,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,1062.34,676.03,1062.34,28,percent of total billed charges,,,33.6,,676.03,676.03,1062.34,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,676.03,676.03,682.07,25,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,1006,1006,1006,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,59.05,59.05,61.35,42,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,465,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,465,,facility
"INJ, ADO-TRASTUZUMAB EMT 1MG",J9354,HCPCS,636,RC,,,,outpatient,,,50.05,5.01,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,43.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,43.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,44.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,10866.23,10866.23,10866.23,193,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,43.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,91.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,46.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,43.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,46.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,88.09,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,44.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,43.63,448,,facility
URINE FLOW MEASUREMENT,51736,CPT,361,RC,,,,outpatient,,,152.14,15.21,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,131.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,266.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,134.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,134.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2440,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,129.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,127.33,2440,,facility
IGH GENE REARRANGE AMP METH,81261,CPT,310,RC,,,,outpatient,,,247.49,24.75,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,197.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,197.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,203.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,399.5,399.5,399.5,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,197.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,413.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,209.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,197.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,209.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,427.75,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,201.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,197.99,448,,facility
"BRACHYTX, NON-STR, HA, I-125",C2634,HCPCS,278,RC,,,,outpatient,,,188.51,18.85,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,66,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,61,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,173.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,173.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,178.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,173.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,362.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,183.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,173.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,183.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,176.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,173.21,362.01,,facility
UNLISTED PX MUSCSKEL GENERAL,20999,CPT,761,RC,,,,outpatient,,,280.86,28.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,243.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,493.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,240.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,236.08,1173,,facility
DRUG ASSAY VEDOLIZUMAB,80280,CPT,301,RC,,,,outpatient,,,48.21,4.82,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,39.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,38.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,80.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,40.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,38.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,40.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,67.5,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,39.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,38.57,448,,facility
ASPERGILLUS ANTIBODY,86606,CPT,302,RC,,,,outpatient,,,18.81,1.88,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,31.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.39,13.39,13.39,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.53,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,15.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,15.05,448,,facility
NJX AA&/STRD II IH NERVES,64425,CPT,361,RC,,,,outpatient,,,823.63,82.36,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,675.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,675.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,695.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,675.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1411.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,716.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,675.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,716.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2712,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,689.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,2712,,facility
XTRNL ECG REC<48 HR SCAN A/R,93226,CPT,731,RC,,,,outpatient,,,72.85,7.29,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,56.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,56.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,58.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,56.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,118,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,59.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,56.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,59.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,725,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,57.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,56.46,725,,facility
DRAINAGE OF RECTAL ABSCESS,45005,CPT,450,RC,,,,outpatient,,,1405.45,140.55,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1179.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,2393.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1213.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1213.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1168.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,2393.57,,facility
TREAT FINGER FRACTURE EACH,26720,CPT,761,RC,,,,outpatient,,,280.86,28.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,243.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,493.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,240.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,236.08,1173,,facility
DILATION OF ANAL SPHINCTER,45905,CPT,361,RC,,,,outpatient,,,1405.45,140.55,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1179.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,2393.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1213.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1213.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3821,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1168.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3821,,facility
ASSAY OF NUCLEOTIDASE,83915,CPT,301,RC,,,,outpatient,,,13.94,1.39,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,23.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.1,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,11.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.15,448,,facility
INITIAL TREATMENT OF BURN(S),16000,CPT,420,RC,,,,outpatient,,,238.44,23.84,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,80,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,197.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,401.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,203.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,203.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,422,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,195.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,80,448,,facility
ASSAY OF AMYLASE,82150,CPT,301,RC,,,,outpatient,,,8.1,0.81,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.76,5.76,5.76,19,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,95,95,95,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,54.24,31.92,54.25,46,percent of total billed charges,,,33.6,,31.92,27.12,54.24,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,31.92,27.12,31.92,11,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,13.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,40,40,47.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.76,5.76,5.76,306,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,6.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,6.48,448,,facility
DRAINAGE OF GUM LESION,41800,CPT,761,RC,,,,outpatient,,,152.14,15.21,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,131.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,266.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,134.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,114.79,114.79,114.79,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,134.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,129.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,127.33,1173,,facility
RADEX OSSEOUS SURVEY INFANT,77076,CPT,320,RC,,,,outpatient,,,130.94,13.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,438.4,438.4,438.4,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,94.7,94.14,94.7,13,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,448,,facility
CRYPTOCOCCUS ANTIBODY,86641,CPT,302,RC,,,,outpatient,,,18.01,1.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,30.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,31.13,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.41,448,,facility
DRUG SCRN QUAN MYCOPHENOLATE,80180,CPT,301,RC,,,,outpatient,,,22.56,2.26,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,37.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.06,16.06,16.06,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.99,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.05,448,,facility
CLTX HUM EPCNDYLR FX WO MNPJ,24560,CPT,450,RC,,,,outpatient,,,280.86,28.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,243.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,493.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,240.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,236.08,1173,,facility
I&D SHOULDER DEEP ABSC/HMTMA,23030,CPT,450,RC,,,,outpatient,,,3384.19,338.42,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2779.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2779.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2863.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2779.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,5810.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2946.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2779.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2946.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2835.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,5810.16,,facility
INJ ENFORT VEDO-EJFV 0.25MG,J9177,HCPCS,636,RC,,,,outpatient,,,45.15,4.52,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,36.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,37.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,36.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,76.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,38.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,36.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,38.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,78.8,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,37.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,36.66,448,,facility
INJ CYCLOPHOS DR REDDYS 5 MG,J9073,HCPCS,636,RC,,,,outpatient,,,0.99,0.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,3032.2,3032.2,3100.61,1239,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,0.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,0.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,0.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,1105.33,1084.65,2994.08,1923,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,1329.52,1282.6,1790.99,848,percent of total billed charges,,,34.6,,645.42,645.42,645.42,114,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,0.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,0.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,0.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,0.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.71,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,0.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,0.5,448,,facility
FXN GENE DETC ABNOR ALLELES,81284,CPT,310,RC,,,,outpatient,,,171.25,17.13,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,137,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,137,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,141.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,137,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,286.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,145.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,137,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,145.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,239.75,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,139.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,137,448,,facility
X-RAY EXAM OF HEEL,73650,CPT,320,RC,,,,outpatient,,,108.23,10.82,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,85.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,174.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,84.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,83.29,448,,facility
RADEX OSSEOUS SURVEY LMTD,77074,CPT,329,RC,,,,outpatient,,,130.94,13.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,448,,facility
X-RAY EXAM SACRUM TAILBONE,72220,CPT,320,RC,,,,outpatient,,,108.23,10.82,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,530.56,530.56,530.56,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,85.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,278.54,278.54,278.54,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,174.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.68,19.68,20.25,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,84.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,83.29,448,,facility
CLTX SCAP FX W/MNPJ +-TRACTJ,23575,CPT,761,RC,,,,outpatient,,,1914.16,191.42,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1585.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3216.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1631.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1631.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,1569.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3216.38,,facility
CHEMODENER MUSCLE LARYNX EMG,64617,CPT,761,RC,,,,outpatient,,,823.63,82.36,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,675.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,675.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,695.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,675.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1411.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,716.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,675.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,716.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,689.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1411.94,,facility
X-RAY EXAM CHEST 4+ VIEWS,71048,CPT,324,RC,,,,outpatient,,,130.94,13.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,448,,facility
EXC H-F-NK-SP B9+MARG >4 CM,11426,CPT,761,RC,,,,outpatient,,,3384.19,338.42,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,2548.7,2511.18,2615.71,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2779.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2779.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2863.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2779.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,5810.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2946.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2779.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2946.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,2835.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,5810.16,,facility
NEG PRS WND THER NDME>50SQCM,97608,CPT,420,RC,,,,outpatient,,,474.9,47.49,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,80,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,390.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,390.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,402.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,390.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,817.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,414.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,390.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,414.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,422,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,398.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,80,817.13,,facility
CALCULUS SPECTROSCOPY,82365,CPT,301,RC,,,,outpatient,,,16.13,1.61,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.47,11.47,11.47,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,31.92,31.92,31.92,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,26.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.47,11.47,11.47,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.86,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.9,448,,facility
G6PD GENE ALYS CMN VARIANT,81247,CPT,310,RC,,,,outpatient,,,218.51,21.85,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,174.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,174.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,180.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,174.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,365.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,185.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,174.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,185.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,305.92,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,178.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,174.81,448,,facility
FETAL BIOPHYS PROFIL W/O NST,76819,CPT,402,RC,,,,outpatient,,,130.94,13.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,40.16,40.16,40.16,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,465,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,465,,facility
ESOPH SCOPE W/SUBMUCOUS INJ,43201,CPT,750,RC,,,,outpatient,,,2266.24,226.62,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,1836.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1836.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1891.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1836.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3838.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1946.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1836.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1946.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3821,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1873.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3838.31,,facility
AMBL BP MNTR W/SW REC ONLY,93786,CPT,480,RC,,,,outpatient,,,152.14,15.21,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,131.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,266.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,134.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,134.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1463,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,129.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,127.33,1463,,facility
USE 1ST TARGET LESION,76982,CPT,402,RC,,,,outpatient,,,130.94,13.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,465,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,465,,facility
COLONOSCOPY W/SNARE,44394,CPT,750,RC,,,,outpatient,,,1405.45,140.55,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1179.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,2393.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1213.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1213.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3821,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1168.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3821,,facility
DENOSUMAB INJECTION,J0897,HCPCS,636,RC,,,,outpatient,,,33.44,3.34,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,30.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,7650.15,7650.15,7920,240,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,30.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,62.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,31.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,30.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,31.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,59.47,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,30.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,30.1,448,,facility
REMOVE ANAL FIST INTER,46275,CPT,360,RC,,,,outpatient,,,3344.05,334.41,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1027,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1519,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,2656.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2656.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2736.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2656.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,5552.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2815.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,2499.5,2499.5,2499.5,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2656.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2815.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9389,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,2709.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,9389,,facility
NFCT AGT GNTYP ALYS CMV,87910,CPT,306,RC,,,,outpatient,,,321.81,32.18,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,257.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,257.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,265.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,257.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,538.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,272.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,257.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,272.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,556.22,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,262.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,257.45,556.22,,facility
EXCIMER LSR PSRIASIS<250SQCM,96920,CPT,940,RC,,,,outpatient,,,238.44,23.84,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,197.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,401.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,203.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,203.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,418,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,195.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,192.01,1173,,facility
INJECT SKIN LESIONS >7,11901,CPT,761,RC,,,,outpatient,,,238.44,23.84,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,197.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,401.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,203.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,1584,1584,1584,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,203.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,195.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,192.01,1173,,facility
CARDIAC MRI W/STRESS IMG,75559,CPT,610,RC,,,,outpatient,,,657.04,65.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1025,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1350,,,,,,,case rate,NTE Percentage + Reimbursement Rate 85.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,522.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,522.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,538.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,522.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1092.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,554.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,522.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,554.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2407,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,533.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,2407,,facility
UNLISTED PX MALE GENITAL SYS,55899,CPT,761,RC,,,,outpatient,,,294.35,29.44,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,239.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,239.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,246.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,239.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,499.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,253.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,239.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,253.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,243.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,239.12,1311,,facility
BRCA2 GENE KNOWN FAMIL VRNT,81217,CPT,310,RC,,,,outpatient,,,469.06,46.91,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,375.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,375.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,386.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,375.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,784.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,397.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,375.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,397.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,656.69,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,382.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,375.25,784.27,,facility
MSH2 GENE DUP/DELETE VARIANT,81297,CPT,310,RC,,,,outpatient,,,266.63,26.66,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,213.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,213.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,219.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,213.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,445.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,226.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,213.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,226.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,373.28,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,217.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,213.3,448,,facility
TREATMENT OF ANKLE FRACTURE,27816,CPT,761,RC,,,,outpatient,,,280.86,28.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,243.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,493.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,240.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,236.08,1173,,facility
INTRINSIC FACTOR ANTIBODY,86340,CPT,302,RC,,,,outpatient,,,18.85,1.89,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,59.14,59.14,74.98,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,31.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.41,13.41,13.41,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.57,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,15.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,15.08,448,,facility
NFCT AGT GNTYP ALYS HIV1,87906,CPT,306,RC,,,,outpatient,,,160.91,16.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,120.95,120.95,120.95,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,128.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,128.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,132.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,108.24,108.24,108.24,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,128.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,269.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,136.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,114.5,114.5,114.5,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,128.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,136.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,278.11,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,131.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,128.73,448,,facility
CT THORAX LUNG CANCER SCR C-,71271,CPT,352,RC,,,,outpatient,,,130.94,13.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,403,,,,,,,case rate,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,371,,,,,,,case rate,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,875,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1050,,,,,,,case rate,NTE Percentage + Reimbursement Rate 85.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,124.08,124.08,124.08,1 through 10,percent of total billed charges,,,33.6,,61.36,61.36,78.96,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,78.96,61.36,78.96,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,126.44,126.44,126.44,1 through 10,percent of total billed charges,,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1522,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,1522,,facility
DRESS/DEBRID P-THICK BURN M,16025,CPT,420,RC,,,,outpatient,,,238.44,23.84,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,80,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,197.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,401.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,203.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,203.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,422,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,195.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,80,1311,,facility
SMALL BOWEL ENDOSCOPY,44372,CPT,750,RC,,,,outpatient,,,2266.24,226.62,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,1836.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1836.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1891.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1836.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3838.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1946.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1836.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1946.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3821,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1873.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3838.31,,facility
CONSLTJ&REPRT SLD PREP ELSWR,88321,CPT,312,RC,,,,outpatient,,,47.76,4.78,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,74.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,55.65,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,36.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.74,448,,facility
REPAIR HAND TENDON,26410,CPT,450,RC,,,,outpatient,,,1914.16,191.42,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1027,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1519,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1585.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3216.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1631.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1631.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1569.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3216.38,,facility
BEHAV CHNG SMOKING 3-10 MIN,99406,CPT,942,RC,,,,outpatient,,,34.18,3.42,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,26.14,26.14,35.86,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,74.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,38.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.19,10.19,10.49,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,38.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,232,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,36.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.86,448,,facility
PROCTOSIGMOIDOSCOPY FB,45307,CPT,750,RC,,,,outpatient,,,3344.05,334.41,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,2656.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2656.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2736.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2656.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,5552.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2815.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2656.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2815.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9389,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,2709.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,9389,,facility
X-RAY EXAM HIP UNI 2-3 VIEWS,73502,CPT,320,RC,,,,outpatient,,,108.23,10.82,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,85.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,174.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,29.93,29.93,30.8,16,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,84.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,83.29,448,,facility
MUSCLE BIOPSY SUPERFICIAL,20200,CPT,761,RC,,,,outpatient,,,1930.94,193.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1628.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3303.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1675.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1675.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,1612.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3303.62,,facility
"INJ, LANREOTIDE, (CIPLA) 1MG",J1932,HCPCS,636,RC,,,,outpatient,,,52.93,5.29,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,20.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,20.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,42.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,21.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,20.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,21.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,65.96,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,20.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,20.33,448,,facility
CSF SHUNT REPROGRAM,62252,CPT,450,RC,,,,outpatient,,,355.74,35.57,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,293.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,293.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,302.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,293.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,614.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,311.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,293.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,311.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,299.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,293.95,614.36,,facility
ENDOMYOCARDIAL BIOPSY,93505,CPT,481,RC,,,,outpatient,,,3796.26,379.63,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,3021.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3021.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3112.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3021.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,6315.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3203.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3021.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3203.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10137,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,3082.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,669,10137,,facility
FIBRINOGEN ANTIGEN,85385,CPT,305,RC,,,,outpatient,,,18.08,1.81,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.86,12.86,12.86,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,30.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.86,12.86,12.86,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.31,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.46,448,,facility
TREAT KNEE FRACTURE(S),27538,CPT,450,RC,,,,outpatient,,,280.86,28.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,243.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,493.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,240.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,236.08,1173,,facility
CHEMO INTRALESIONAL UP TO 7,96405,CPT,331,RC,,,,outpatient,,,83.9,8.39,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,68.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,68.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,70.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,68.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,144.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,73.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,63.38,63.38,63.38,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,68.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,73.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1603,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,70.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,68.91,1603,,facility
REPAIR EYELID WOUND,67935,CPT,361,RC,,,,outpatient,,,2783.1,278.31,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,2275.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2275.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2343.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2275.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,4755.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2411.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2275.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2411.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9389,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,2320.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,9389,,facility
ISLAND PEDICLE FLAP GRAFT,15740,CPT,761,RC,,,,outpatient,,,2171.91,217.19,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1974.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1974.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2033.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1974.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,4127.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2093.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1974.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2093.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,2014.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,4127.08,,facility
UNLISTED PROCEDURE ESOPHAGUS,43499,CPT,750,RC,,,,outpatient,,,1079.61,107.96,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,868.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,868.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,894.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,868.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1814.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,920.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,868.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,920.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3821,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,885.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3821,,facility
TREATMENT OF TOE FRACTURE,28510,CPT,761,RC,,,,outpatient,,,280.86,28.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,243.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,493.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,240.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,236.08,1173,,facility
HISTOPLASMA CAPSUL AG IA,87385,CPT,306,RC,,,,outpatient,,,569,56.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,126.26,126.26,126.26,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,225.98,225.98,225.98,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.79,11.79,13.25,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.9,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.25,448,,facility
FLUORESCENT ANTIBODY SCREEN,86255,CPT,302,RC,,,,outpatient,,,1425,142.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.72,10.72,10.72,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,45.41,28.9,1068.67,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,28.9,28.9,28.9,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.72,10.72,10.72,19,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.04,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.05,448,,facility
SPECIMEN INFECT AGNT CONCNTJ,87015,CPT,306,RC,,,,outpatient,,,40,4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.94,5.94,5.94,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,13.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,7.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.94,5.94,5.94,23,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,7.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.42,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,6.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,6.68,448,,facility
CMPLX RPR TRUNK ADDL 5CM/<,13102,CPT,450,RC,,,,outpatient,,,725,72.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,56.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,56.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,58.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,56.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,119,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,60.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,56.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,60.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,58.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,56.94,1173,,facility
HSV DNA AMP PROBE,87529,CPT,306,RC,,,,outpatient,,,250,25,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,244.61,244.61,244.61,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
ASSAY OF B HEXOSAMINIDASE EA,83080,CPT,301,RC,,,,outpatient,,,245,24.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,35.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.45,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,16.87,448,,facility
NDL EMG LMTD STD MUSC 1 XTR,95870,CPT,922,RC,,,,outpatient,,,319,31.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,131.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,266.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,134.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,134.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,478,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,129.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,127.33,478,,facility
TEST FOR EXERCISE-INDUCED SPASM OF LUNG AIRWAYS,94617,CPT,0460,RC,,,,outpatient,,,2992,299.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,113.1,113.1,122.61,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,131.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,266.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,134.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,47.15,47.15,47.15,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,134.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,611,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,129.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,127.33,611,,facility
LATERAL THORACIC EXTENSION,L1210,HCPCS,274,RC,,,,outpatient,,,448,44.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,66,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,61,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,300.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,300.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,309.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,300.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,628.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,318.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,300.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,318.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,306.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,300.68,628.42,,facility
ENCEPHALTIS EAST EQNE ANBDY,86652,CPT,302,RC,,,,outpatient,,,70,7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.49,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.19,448,,facility
TOPOTECAN INJECTION,J9351,HCPCS,636,RC,,,,outpatient,,,9,0.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",448,448,,facility
CYTOGENETICS 100-300,88275,CPT,311,RC,,,,outpatient,,,2077,207.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,45.53,45.53,45.53,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,51.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,51.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,52.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,1828.51,1828.51,1828.51,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,401.18,401.18,401.18,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,51.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,106.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,54.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,45.53,45.53,45.53,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,51.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,54.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,89.58,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,52.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,51.19,448,,facility
REMOVAL OF FOREIGN BODY OF FOOT TISSUE; ACCESSED BENEATH THE SKIN,28190,CPT,0450,RC,,,,outpatient,,,1711,171.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,677.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,677.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,698.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,677.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1416.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,718.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,626.56,626.56,626.56,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,677.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,718.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,691.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1416.43,,facility
ENZYME CELL ACTIVITY RA,82658,CPT,301,RC,,,,outpatient,,,200,20,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,44.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,44.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,45.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,44.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,92.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,46.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,44.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,46.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,77.05,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,44.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,44.03,448,,facility
DETECTION TEST BY IMMUNOASSAY TECHNIQUE FOR HEPATITIS B SURFACE ANTIGEN,87340,CPT,0306,RC,,,,outpatient,,,414,41.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9.19,9.19,9.19,137,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,51.92,51.92,51.92,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,46.46,29.57,140.35,57,percent of total billed charges,,,33.6,,46.46,29.57,46.46,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,29.57,29.57,29.92,75,percent of total billed charges,,,34.6,,34.67,12.1,42.83,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,21.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,44,44,44.13,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,9.19,9.19,9.19,1 through 10,percent of total billed charges,,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9.19,9.19,9.19,421,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.31,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,10.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,10.33,448,,facility
REVIEW BY RADIOLOGIST OF URINARY BLADDER AND URETHRA IMAGES WITH CONTRAST,74450,CPT,0320,RC,,,,outpatient,,,1345,134.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,235.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,603.91,603.91,603.91,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,477.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,242.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,672.5,672.5,672.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,242.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,232.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,228.36,477.27,,facility
IMMUNOASSAY NONANTIBODY,83516,CPT,301,RC,,,,outpatient,,,197,19.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9,9,10.26,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,4.75,4.75,218.59,30,percent of total billed charges,,,33.6,,3.02,3.02,175.39,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,3.02,3.02,211.68,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,24.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,23.5,23.5,23.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9,9,10.26,51,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.92,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,11.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.53,448,,facility
ASSAY OF THYROGLOBULIN,84432,CPT,301,RC,,,,outpatient,,,210,21,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,14.29,14.29,14.29,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,5.9,5.9,33.04,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,5.28,3.36,29.57,1 through 10,percent of total billed charges,,,33.6,,14.58,14.58,18.82,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,14.58,3.36,18.82,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,33.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,14.29,10,14.29,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,34.7,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,16.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,16.06,448,,facility
ESTABLISHED PATIENT PERIODIC PREVENTIVE MEDICINE EXAMINATION (YOUNGER THAN 1 YEAR),99391,CPT,0770,RC,,,,outpatient,,,462,46.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,57.79,57.79,57.79,83,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,261.49,152.61,300.55,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
REMOVAL OF IMPACTED EAR WAX BY WASHING,69209,CPT,0450,RC,,,,outpatient,,,171,17.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,56.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,56.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,58.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,56.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,118,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,59.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,56.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,59.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,57.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,56.46,1173,,facility
ASSAY OF VITAMIN B-1,84425,CPT,301,RC,,,,outpatient,,,240,24,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,18.88,18.88,18.88,41,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,39.83,39.83,39.83,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,35.9,35.64,35.9,1 through 10,percent of total billed charges,,,33.6,,22.88,22.88,22.88,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,22.85,22.85,22.88,16,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,21.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,44.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,18.88,18.88,18.88,118,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,21.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,45.87,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,21.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,21.23,448,,facility
INFUSION INTO A VEIN FOR THERAPY; PREVENTION; OR DIAGNOSIS CONCURRENT WITH ANOTHER INFUSION,96368,CPT,0260,RC,,,,outpatient,,,257,25.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,213.76,197.06,213.76,30,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,52.8,,176.35,112.22,176.35,1 through 10,percent of total billed charges,,,33.6,,112.22,112.22,112.22,21,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,112.22,112.22,112.22,11,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,29.94,29.94,29.94,49,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,427,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",427,448,,facility
SYPHILIS TEST NON-TREP QUAL,86592,CPT,302,RC,,,,outpatient,,,87,8.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.8,3.8,3.8,262,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,28.8,3.16,28.8,20,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,26.55,26.4,79.65,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,28.8,28.8,28.8,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,23.76,15.12,23.76,39,percent of total billed charges,,,33.6,,15.17,15.12,45.36,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,15.12,15.12,15.17,34,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,8.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,22.38,22.38,22.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.8,3.8,3.8,282,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.22,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,4.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,4.27,448,,facility
MRI SCAN OF BLOOD VESSELS OF NECK WITHOUT CONTRAST,70547,CPT,0610,RC,,,,outpatient,,,5094,509.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,474.04,474.04,474.04,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,802,802,802,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1025,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1350,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,235.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,477.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,242.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,242.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2407,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,232.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,228.36,2407,,facility
ALLG SPEC IGE RECOMB EA,86008,CPT,302,RC,,,,outpatient,,,105,10.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,37.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.75,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.93,448,,facility
RED BLOOD CELLS; DEGLYCEROLIZED; EACH UNIT,P9039,HCPCS,0390,RC,,,,outpatient,,,3475,347.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,311.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,311.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,320.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,311.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,650.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,330.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,311.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,330.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,107,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,317.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,107,650.97,,facility
IMMUNODIFFUSION OUCHTERLONY,86331,CPT,302,RC,,,,outpatient,,,61,6.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.66,10.66,10.66,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.88,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.98,448,,facility
COMPLETE ULTRASOUND SCAN OF ABDOMEN,76700,CPT,0402,RC,,,,outpatient,,,2532,253.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,93.3,93.3,268.93,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,1620.48,1620.48,1620.48,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,1336.9,850.75,1336.9,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,850.75,850.75,850.75,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,1266,1266,1266,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,62.56,62.56,62.56,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,465,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,465,,facility
"INJECTION, NIVOLUMAB",J9299,HCPCS,636,RC,,,,outpatient,,,130,13,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,34.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,34.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,32947.2,32947.2,32947.2,4320,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,34.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,71.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,36.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,34.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,36.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,69.45,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,34.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,34.22,448,,facility
APOLIPOPROTEIN LEVEL,82172,CPT,0301,RC,,,,outpatient,,,60,6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,18.76,18.76,18.76,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,22.18,20.16,31.68,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,20.16,20.16,20.34,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,21.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,44.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,18.76,18.76,18.76,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,21.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.91,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,21.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,21.09,448,,facility
RSV VACC PREF RECOMB ADJT IM,90679,CPT,636,RC,,,,outpatient,,,325,32.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
MEASUREMENT OF ACTIN (SMOOTH MUSCLE) ANTIBODY,86015,CPT,0302,RC,,,,outpatient,,,59.75,5.98,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.72,10.72,10.72,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,12.1,12.1,31.68,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,20.16,20.16,20.16,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.72,10.72,10.72,43,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.18,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.05,448,,facility
HPV HI-RISK TYP POOLED RSLT,87624,CPT,306,RC,,,,outpatient,,,306,30.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,51,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,57.23,57.23,57.23,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,85.34,51.22,134.11,1 through 10,percent of total billed charges,,,33.6,,32.59,32.59,85.34,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,85.34,75.94,85.34,14,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,112,48.5,112,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,20.37,20.37,53.34,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,80,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
THERAPY PROCEDURE USING A SPECIAL BANDAGE AND VACUUM PUMP; SURFACE AREA 50.0 SQ CM OR LESS,97605,CPT,0420,RC,,,,outpatient,,,459,45.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,80,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,192.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,192.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,198.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,192.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,403.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,204.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,192.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,204.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,422,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,196.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,80,448,,facility
APPLICATION OF SHORT LEG CAST,29405,CPT,0450,RC,,,,outpatient,,,1001,100.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,267.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,267.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,275.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,267.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,559.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,283.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,236.5,236.5,236.5,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,267.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,283.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,273.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,267.68,559.45,,facility
PLATELET COUNT; AUTOMATED TEST,85049,CPT,0305,RC,,,,outpatient,,,40,4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,9.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.98,3.98,3.98,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.68,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,4.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,4.48,448,,facility
CULTURE AEROBIC QUANT OTHER,87071,CPT,306,RC,,,,outpatient,,,12.36,1.24,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,9.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,20.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,9.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.41,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,10.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,9.89,448,,facility
TREATMENT OF FIBULA FRACTURE,27780,CPT,450,RC,,,,outpatient,,,280.86,28.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,243.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,493.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,240.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,236.08,1173,,facility
DRUG SCREENING BUPRENORPHINE,80348,CPT,301,RC,,,,outpatient,,,277,27.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
LIPASE (FAT ENZYME) LEVEL,83690,CPT,0301,RC,,,,outpatient,,,110,11,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,6.13,6.13,6.13,44,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,81.65,42.15,81.65,67,percent of total billed charges,,,33.6,,48.05,19.01,48.05,11,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,48.05,37.29,48.05,74,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,14.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,7.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,18,18,71.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,6.13,6.13,6.13,696,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,7.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.89,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,7.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,6.89,448,,facility
URINALYSIS AUTO W/SCOPE,81001,CPT,307,RC,,,,outpatient,,,381,38.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,2.82,2.82,2.82,418,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,229.76,25.6,256,88,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,211.81,23.6,236,14,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,204.99,21.12,228.4,143,percent of total billed charges,,,33.6,,134.4,21.12,189.55,25,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,121.7,13.44,135.6,151,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,6.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,179.5,20,200,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,8.4,8.4,84,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,2.82,2.82,2.82,1909,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.86,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,3.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,3.17,448,,facility
MOPATH PROCEDURE LEVEL 9,81408,CPT,310,RC,,,,outpatient,,,1192,119.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2000,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2000,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2060,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2000,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,4180,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2120,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2000,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2120,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3500,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,2040,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,4180,,facility
PLATELET AGGREGATION FUNCTION TEST,85576,CPT,0305,RC,,,,outpatient,,,210,21,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,22.16,22.16,22.16,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,70.56,70.56,70.56,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,24.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,52.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,26.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,22.16,22.16,22.16,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,24.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,26.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,46.41,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,25.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,24.91,448,,facility
CLOSED TREATMENT OF DISLOCATED HIP,27250,CPT,0450,RC,,,,outpatient,,,2910,291,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,243.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,493.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,240.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,236.08,1173,,facility
QUANTITATIVE ASSAY DRUG,80299,CPT,301,RC,,,,outpatient,,,393,39.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,13,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,174.64,174.64,174.64,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,171.6,171.6,171.6,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,374.52,374.52,374.52,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.62,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.64,448,,facility
IMMUNOASSAY QUANT NOS NONAB,83520,CPT,301,RC,,,,outpatient,,,100,10,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,36,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,66.08,66.08,66.08,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,41.18,24.82,318.38,1 through 10,percent of total billed charges,,,33.6,,37.63,37.63,96.43,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,33.6,23.18,176.4,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,36.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,87,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.22,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.27,448,,facility
REMOVAL OF NONCANCER SKIN GROWTH OF SCALP; NECK; HANDS; FEET; OR GENITALS; 2.1-3.0 CM,11423,CPT,0761,RC,,,,outpatient,,,2910,291,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1628.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3303.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1675.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,1442.85,1442.85,1442.85,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1675.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,1612.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3303.62,,facility
THROMBOPLASTIN INHIBITION,85705,CPT,305,RC,,,,outpatient,,,285,28.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,9.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,20.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,9.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.81,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,9.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,9.63,448,,facility
PUNCTURE OF SKIN FOR COLLECTION OF BLOOD SAMPLE,36416,CPT,0300,RC,,,,outpatient,,,120,12,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,63.36,63.36,63.36,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,40.32,40.32,40.32,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,50,,8,8,60,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,20.96,20.96,20.96,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.04,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",5.04,448,,facility
COMPLICATED REPAIR OF WOUND OF SCALP; ARMS; OR LEGS; 2.6-7.5 CM,13121,CPT,0450,RC,,,,outpatient,,,3143,314.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,358.86,358.86,366.07,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,1027,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1519,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,400.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,1794.65,1794.65,1794.65,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,813.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,412.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,545.11,545.11,545.11,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,412.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,396.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,389.05,1519,,facility
EUGLOBULIN LYSIS (CLOT DISSOLVING) MEASUREMENT,85360,CPT,0305,RC,,,,outpatient,,,180,18,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,17.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.17,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,8.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,8.41,448,,facility
THERAPY PROCEDURE USING FUNCTIONAL ACTIVITIES,97530,CPT,0420,RC,,,,outpatient,,,125,12.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,51.96,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,89.84,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,80,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,33.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,32.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,68.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,34.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,32.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,34.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,422,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,33.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,32.85,448,,facility
IMMUNOLOGIC ANALYSIS FOR DETECTION OF TUMOR ANTIGEN; QUANTITATIVE; CA 125,86304,CPT,0302,RC,,,,outpatient,,,370,37,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,18.51,18.51,18.51,13,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,29.13,29.13,29.13,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,195.36,59.14,195.36,12,percent of total billed charges,,,33.6,,59.14,59.14,125.43,21,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,124.32,37.63,125.43,21,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,20.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,43.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,185,56.13,185,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,77.7,77.7,77.7,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,18.51,18.51,18.51,51,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,20.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,44.98,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,21.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,20.81,448,,facility
IMAGING OF ORGAN; COMPLIMENTING ROUTINE EXAM,76125,CPT,0320,RC,,,,outpatient,,,112,11.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,82.56,82.56,82.56,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,43.34,43.34,43.34,1 through 10,percent of total billed charges,,,33.6,,43.34,43.34,43.34,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,43.34,43.34,43.34,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.34,448,,facility
NERVE CONDUCTION; 7-8 STUDIES,95910,CPT,0922,RC,,,,outpatient,,,1018,101.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,273.22,273.22,357.13,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,357.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,357.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,367.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,357.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,746.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,378.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,56.64,56.64,56.64,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,357.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,378.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,478,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,364.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,357.13,746.4,,facility
DOCETAXEL INJECTION,J9171,HCPCS,636,RC,,,,outpatient,,,6,0.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,4335.06,4335.06,5807.35,699,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,52.8,,2816.13,266.45,4588.62,1175,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,313.24,313.24,313.24,154,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",448,448,,facility
IMMUNOASSAY NONANTIBODY,83516,CPT,301,RC,,,,outpatient,,,110,11,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9,9,10.26,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,4.75,4.75,218.59,30,percent of total billed charges,,,33.6,,3.02,3.02,175.39,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,3.02,3.02,211.68,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,24.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,23.5,23.5,23.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9,9,10.26,51,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.92,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,11.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.53,448,,facility
MTHFR GENE,81291,CPT,310,RC,,,,outpatient,,,290,29,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,65.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,65.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,67.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,65.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,136.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,69.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,65.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,69.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,114.35,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,66.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,65.34,448,,facility
ISLET CELL ANTIBODY,86341,CPT,302,RC,,,,outpatient,,,866,86.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,20.97,20.97,20.97,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,23.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,23.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,143.62,143.62,326.83,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,258.38,258.38,258.38,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,23.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,49.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,24.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,20.97,20.97,20.97,14,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,23.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,24.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.75,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,24.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,23.57,448,,facility
ASSAY OF BIOTINIDASE,82261,CPT,301,RC,,,,outpatient,,,116,11.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.01,15.01,15.01,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,35.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.01,15.01,15.01,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.45,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,16.87,448,,facility
OXALIPLATIN,J9263,HCPCS,636,RC,,,,outpatient,,,3,0.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,107.52,86.48,134.4,3765,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,52.8,,96.75,77.62,371.49,1764,percent of total billed charges,,,33.6,,65.97,50.8,265.31,7338,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,33.52,33.34,268.13,945,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",448,448,,facility
SHRINKER BELOW KNEE,L8440,HCPCS,274,RC,,,,outpatient,,,82,8.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,66,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,61,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,54.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,54.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,55.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,54.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,113.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,57.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,54.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,57.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,55.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,54.07,113.01,,facility
REMOVAL OF NONCANCER SKIN GROWTH OF FACE; EARS; EYELIDS; NOSE; LIPS; OR MOUTH; 2.1-3.0 CM,11443,CPT,0761,RC,,,,outpatient,,,3201,320.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,1421.6,1421.6,1487.27,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1628.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3303.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1675.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,1442.85,1442.85,1442.85,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1675.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,1612.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3303.62,,facility
REPAIR OF LACERATED TONGUE OR FLOOR OF MOUTH; MORE THAN 2.6 CM,41252,CPT,0450,RC,,,,outpatient,,,3201,320.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,203.75,203.75,203.75,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,226.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,226.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,233.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,226.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,473.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,240.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,226.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,240.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,231.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,226.68,1311,,facility
EXC TR-EXT B9+MARG 0.5 CM<,11400,CPT,761,RC,,,,outpatient,,,3143,314.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,677.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,677.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,698.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,677.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1416.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,718.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,677.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,718.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,691.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1416.43,,facility
ISCH CONTAINMT/NARROW M-L SO,L5649,HCPCS,274,RC,,,,outpatient,,,4414,441.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,66,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,61,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Stoploss First Dollar + Reimbursement Rate 50.00 + Percent Of Charge + Reimbursement Rate 0.00 + Fixed Amount 3149.00,,,,0,other,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,Stoploss First Dollar + Reimbursement Rate 50.00 + Percent Of Charge + Reimbursement Rate 0.00 + Fixed Amount 3149.00,,,,0,other,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,2974.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2974.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3063.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2974.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,6216.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3153.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2974.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3153.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,3034.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,2974.58,6216.87,,facility
INSERTION OF ARTERY TUBE FOR BLOOD SAMPLING OR INFUSION THROUGH SKIN,36620,CPT,0450,RC,,,,outpatient,,,2421,242.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,39.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,39.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,40.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,39.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,82.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,41.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,39.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,41.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,40.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,39.58,1173,,facility
DEHYDROEPIANDROSTERONE,82627,CPT,301,RC,,,,outpatient,,,306,30.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.77,19.77,19.77,24,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,44.25,44.25,44.25,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,39.6,39.6,142.03,1 through 10,percent of total billed charges,,,33.6,,25.2,25.2,25.2,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,25.2,25.2,90.38,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,46.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,23.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.77,19.77,19.77,42,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,23.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,48.04,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,22.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,22.23,448,,facility
THERAPEUTIC EXERCISES,97110,CPT,420,RC,,,,outpatient,,,218,21.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,51.96,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,89.84,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,80,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,27.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,57.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,29.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,101.92,101.92,101.92,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,27.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,29.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,422,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,28.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,27.52,448,,facility
PROTEIN WESTERN BLOT TEST,84182,CPT,301,RC,,,,outpatient,,,630,63,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,217.54,217.54,217.54,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,29.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,61.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,30.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,25.98,25.98,25.98,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,29.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,30.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,51.12,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,29.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,29.21,448,,facility
IMMUNOASSAY QUANT NOS NONAB,83520,CPT,301,RC,,,,outpatient,,,112,11.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,36,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,66.08,66.08,66.08,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,41.18,24.82,318.38,1 through 10,percent of total billed charges,,,33.6,,37.63,37.63,96.43,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,33.6,23.18,176.4,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,36.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,87,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.22,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.27,448,,facility
CYTOGENETICS 100-300,88275,CPT,311,RC,,,,outpatient,,,665,66.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,45.53,45.53,45.53,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,51.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,51.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,52.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,1828.51,1828.51,1828.51,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,401.18,401.18,401.18,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,51.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,106.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,54.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,45.53,45.53,45.53,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,51.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,54.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,89.58,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,52.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,51.19,448,,facility
CLOT FACTOR VIII AHG 1 STAGE,85240,CPT,305,RC,,,,outpatient,,,309,30.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.92,15.92,15.92,48,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,98.21,62.5,349.44,1 through 10,percent of total billed charges,,,33.6,,62.5,62.5,62.5,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,62.88,62.5,62.88,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,37.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,93,92.75,93,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.92,15.92,15.92,80,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.68,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.9,448,,facility
CYTOGENETICS DNA PROBE,88271,CPT,311,RC,,,,outpatient,,,737,73.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.05,19.05,19.05,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,1274.11,1274.11,1274.11,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,477.79,477.79,477.79,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,21.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,44.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.05,19.05,19.05,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,21.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,46.27,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,21.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,21.42,448,,facility
DECLOTTING OF CENTRAL VENOUS TUBE,36593,CPT,0510,RC,,,,outpatient,,,1143,114.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,316.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,316.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,325.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,316.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,660.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,335.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,316.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,335.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,322.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,316.12,1173,,facility
AMINO ACIDS SINGLE QUANT,82131,CPT,301,RC,,,,outpatient,,,39,3.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,23.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,48.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,24.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,24.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,40.22,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,23.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,22.98,448,,facility
X-RAY OF ANKLE; 2 VIEWS,73600,CPT,0320,RC,,,,outpatient,,,708,70.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,85.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,174.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.68,19.68,20.53,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,84.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,83.29,448,,facility
IMMUNOASSAY TUMOR OTHER,86316,CPT,302,RC,,,,outpatient,,,82,8.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,18.51,18.51,18.51,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,76.03,32.21,76.03,1 through 10,percent of total billed charges,,,33.6,,48.38,48.38,48.38,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,20.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,43.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,18.51,18.51,18.51,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,20.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,44.98,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,21.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,20.81,448,,facility
TISSUE EXAM FOR FUNGI,87220,CPT,306,RC,,,,outpatient,,,387,38.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.8,3.8,3.8,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,8.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.8,3.8,3.8,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.22,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,4.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,4.27,448,,facility
STANCE PHASE ONLY,L5858,HCPCS,274,RC,,,,outpatient,,,33815,3381.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,66,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,61,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Stoploss First Dollar + Reimbursement Rate 50.00 + Percent Of Charge + Reimbursement Rate 0.00 + Fixed Amount 3149.00,,,,0,other,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,Stoploss First Dollar + Reimbursement Rate 50.00 + Percent Of Charge + Reimbursement Rate 0.00 + Fixed Amount 3149.00,,,,0,other,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,23006.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,23006.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,23697.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,23006.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,48084.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,24387.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,23006.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,24387.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,23467.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,23006.91,48084.44,,facility
ASSAY GLUCOSE BLOOD QUANT,82947,CPT,301,RC,,,,outpatient,,,22,2.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.5,3.5,3.5,64,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,14.08,14.08,14.08,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,49.11,28.9,49.11,12,percent of total billed charges,,,33.6,,28.9,28.9,28.9,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,7.46,7.39,56.98,14,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,8.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,43,43,43,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.5,3.5,3.5,54,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.49,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,4.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,3.93,448,,facility
ASSAY OF ACTH,82024,CPT,301,RC,,,,outpatient,,,515,51.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,34.35,34.35,34.35,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,39.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,66.53,24.82,71.95,1 through 10,percent of total billed charges,,,33.6,,42.34,42.34,42.34,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,32.88,32.88,32.88,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,38.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,80.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,40.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,23.5,23.5,23.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,34.35,34.35,34.35,14,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,38.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,40.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.44,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,39.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,38.62,448,,facility
EXAM OF THE NOSE AND THROAT USING AN ENDOSCOPE,92511,CPT,0450,RC,,,,outpatient,,,624,62.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,191.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,191.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,196.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,191.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,399.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,202.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,191.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,202.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,194.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,191.04,1173,,facility
ENCEPHALTIS ST LOUIS ANTBODY,86653,CPT,302,RC,,,,outpatient,,,70,7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.49,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.19,448,,facility
PRETREATMENT OF SERUM FOR USE IN RED BLOOD CELL ANTIBODY ANALYSIS AND MEASUREMENT; BY DIFFERENTIAL RED CELL ABSORPTION,86978,CPT,0302,RC,,,,outpatient,,,824,82.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,56.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,56.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,58.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,870.14,870.14,1411.51,17,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,56.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,118,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,59.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,56.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,59.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,55.65,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,57.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,55.65,448,,facility
NFCT AGT GNTYP ALYS CMV,87910,CPT,306,RC,,,,outpatient,,,1400,140,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,257.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,257.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,265.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,257.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,538.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,272.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,257.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,272.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,556.22,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,262.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,257.45,556.22,,facility
TISSUE EXAM BY PATHOLOGIST,88305,CPT,310,RC,,,,outpatient,,,1328,132.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,46.88,46,49.87,105,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,110.08,49.16,384,85,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,50.74,50.74,50.74,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,49.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,49.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,51.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,175.11,101.7,617.76,173,percent of total billed charges,,,33.6,,131.04,28.9,262.08,20,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,131.04,28.98,393.12,144,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,49.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,104.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,52.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,195,195,585,28,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,81.9,18.06,81.9,1 through 10,percent of total billed charges,,,35,,63.53,63.53,63.53,1 through 10,percent of total billed charges,,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,28.85,28.85,29.69,580,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,49.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,52.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,78.23,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,50.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,49.87,448,,facility
HEP B SURFACE AG NEUTRLZJ IA,87341,CPT,306,RC,,,,outpatient,,,255,25.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,21.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.31,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,10.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,10.33,448,,facility
SHOE LIFTS TAPERED TO ONE-HA,L3332,HCPCS,274,RC,,,,outpatient,,,137,13.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,66,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,61,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,91.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,91.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,93.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,91.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,190.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,96.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,91.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,96.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,92.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,91.13,190.46,,facility
SYPHILIS TEST,86593,CPT,0302,RC,,,,outpatient,,,47.75,4.78,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.91,3.91,3.91,33,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,30.56,30.56,30.72,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,30.72,30.72,30.72,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,25.34,25.34,49.68,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,9.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.91,3.91,3.91,34,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.52,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,4.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,4.4,448,,facility
DETECT AGNT MULT DNA AMPLI,87801,CPT,306,RC,,,,outpatient,,,1475,147.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,70.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,70.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,72.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,70.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,146.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,74.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,62.44,62.44,62.44,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,70.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,74.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,151.66,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,71.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,70.2,448,,facility
ASSAY NEPHELOMETRY NOT SPEC,83883,CPT,301,RC,,,,outpatient,,,735,73.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.1,12.1,12.1,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,173.18,51.22,173.18,1 through 10,percent of total billed charges,,,33.6,,31.58,31.58,31.58,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,31.58,31.53,110.21,11,percent of total billed charges,,,34.6,,119.06,117.35,124.97,24,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,28.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.1,12.1,12.1,29,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.38,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.6,448,,facility
INJ TRUXIMA 10 MG,Q5115,HCPCS,636,RC,,,,outpatient,,,210,21,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,9004.8,9004.8,9408,137,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,34.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,34.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,34.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,72.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,36.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,34.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,36.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,68.43,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,34.56,448,,facility
AK 4 BAR LINK W/FRIC SWING,L5611,HCPCS,274,RC,,,,outpatient,,,2926,292.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,66,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,61,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1972.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1972.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2031.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1972.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,4122.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2090.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1972.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2090.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,2011.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,1972.47,4122.46,,facility
DRUG SCREEN AMPHETAMINES 1/2,80324,CPT,301,RC,,,,outpatient,,,64,6.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
DETECT AGENT NOS DNA AMP,87798,CPT,306,RC,,,,outpatient,,,1146,114.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,110.88,110.88,174.24,1 through 10,percent of total billed charges,,,33.6,,244.27,244.27,244.27,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,96.77,32.38,119.79,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,38.9,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
WBC ANTIBODY IDENTIFICATION,86021,CPT,302,RC,,,,outpatient,,,65,6.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.39,13.39,13.39,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,20.59,13.1,38.54,1 through 10,percent of total billed charges,,,33.6,,134.11,134.11,134.11,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,13.1,13.1,13.1,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,31.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.39,13.39,13.39,23,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.53,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,15.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,15.05,448,,facility
HYDRALAZINE HCL INJECTION,J0360,HCPCS,636,RC,,,,outpatient,,,63,6.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,52.8,,19.82,19.82,26.49,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,19.82,19.82,21.17,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,50,,31.5,31.5,31.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",448,448,,facility
RHEUMATOID FACTOR QUANT,86431,CPT,302,RC,,,,outpatient,,,56,5.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.04,5.04,5.04,26,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,33.63,33.63,33.63,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,30.1,19.05,30.1,1 through 10,percent of total billed charges,,,33.6,,19.15,19.15,30.1,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,19.15,19.15,19.24,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,11.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.04,5.04,5.04,75,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.25,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.67,448,,facility
STEREOISOMER ANALYSIS,80374,CPT,301,RC,,,,outpatient,,,64,6.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
UGT1A1 GENE COMMON VARIANTS,81350,CPT,310,RC,,,,outpatient,,,2140,214,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,234,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,234,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,241.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,234,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,489.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,248.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,234,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,248.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,409.5,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,238.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,234,489.06,,facility
REMOVAL OF INDWELLING TUBE IN LINING OF LUNG,32552,CPT,0761,RC,,,,outpatient,,,1781,178.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,600.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,600.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,618.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,600.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1254.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,636.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,600.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,636.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,612.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1254.75,,facility
INSERTION OF TUBE INTO BRAIN ARTERY FOR DIAGNOSIS OR TREATMENT WITH REVIEW BY RADIOLOGIST,36226,CPT,0323,RC,,,,outpatient,,,19997,1999.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1027,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1519,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5325.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5325.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5485.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5325.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,11130.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5645.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5010.85,5010.85,5010.85,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5325.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5645.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5432.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,443,11130.36,,facility
INITIAL CUSTOM SOCKET INSERT,L5683,HCPCS,274,RC,,,,outpatient,,,2394,239.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,66,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,61,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1628.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1628.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1677.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1628.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3403.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1726.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1628.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1726.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,1660.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,1628.34,3403.23,,facility
INSERTION OF TUBE IN RIGHT HEART CHAMBERS FOR MEASUREMENT,93451,CPT,0480,RC,,,,outpatient,,,22353,2235.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,2822.09,2822.09,2822.09,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 6500.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 10000.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,3102.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3102.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3195.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3102.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,6484.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3288.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,557.68,0.14,602.26,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3102.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3288.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1463,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,3164.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,669,6484.66,,facility
SIGMOIDOSCOPY W/ABLATION,45346,CPT,750,RC,,,,outpatient,,,4873,487.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1179.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,2393.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1213.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1213.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3821,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1168.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3821,,facility
VIRUS ANTIBODY NOS,86790,CPT,302,RC,,,,outpatient,,,489,48.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.46,11.46,11.46,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,107.86,20.06,169.49,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,116.52,40.29,122.3,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,26.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.46,11.46,11.46,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.88,448,,facility
PROCALCITONIN (HORMONE) LEVEL,84145,CPT,0301,RC,,,,outpatient,,,320,32,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,24.21,24.21,24.21,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,182.72,107.52,215.04,1 through 10,percent of total billed charges,,,33.6,,99.54,99.54,107.52,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,107.52,33.6,108.48,15,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,27.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,56.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,28.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,160,160,160,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,24.21,24.21,24.21,349,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,27.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,28.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,57.89,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,27.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,27.22,448,,facility
COMPUTED TOMOGRAPHY (CT) OF BRAIN BLOOD FLOW; VOLUME; AND TIMING OF FLOW ANALYSIS WITH CONTRAST,0042T,CPT,0350,RC,,,,outpatient,,,6642,664.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,875,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1050,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,"Payer contract is 100.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 103.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment.",,,,0,other,"Payer contract is 103.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment. + No services performed during 15-month lookback period",,52.8,,3792.58,3792.58,3792.58,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment. + No services performed during 15-month lookback period",,,"Payer contract is 209.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment.",,,,0,other,"Payer contract is 209.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment. + No services performed during 15-month lookback period",,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment. + No services performed during 15-month lookback period",,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1522,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,"Payer contract is 102.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment.",,,,0,other,"Payer contract is 102.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment. + No services performed during 15-month lookback period",448,1522,,facility
ASSAY IGA/IGD/IGG/IGM EACH,82784,CPT,301,RC,,,,outpatient,,,130,13,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,8.27,8.27,8.27,98,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,114.46,59,343.38,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,52.8,30.49,158.4,64,percent of total billed charges,,,33.6,,19.58,19.49,33.6,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,53.09,19.49,195.55,67,percent of total billed charges,,,34.6,,190.57,73.91,336.04,67,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,9.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,19.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,9.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,29,29,50,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,8.27,8.27,8.27,371,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,9.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,9.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.09,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,9.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,9.3,448,,facility
BIOPSY OF LINING OF UTERUS,58100,CPT,0761,RC,,,,outpatient,,,539,53.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,176.51,176.51,182.06,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,193.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,193.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,199.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,193.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,404.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,205.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,179.14,179.14,210.91,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,193.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,205.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,197.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,193.49,1173,,facility
CHIMERISM ANAL W/CELL SELECT,81268,CPT,310,RC,,,,outpatient,,,900,90,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,231.97,231.97,231.97,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,2152.96,2152.96,2152.96,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,260.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,260.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,268.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,653.4,653.4,685.8,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,1130.3,495.96,1221.13,22,percent of total billed charges,,,34.6,,1221.13,1221.13,2354.8,12,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,260.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,545.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,276.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,231.97,231.97,231.97,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,260.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,276.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,563.43,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,266.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,260.79,563.43,,facility
"FERUMOXYTOL, NON-ESRD",Q0138,HCPCS,636,RC,,,,outpatient,,,5,0.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,0.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,0.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,0.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,856.8,856.8,856.8,1020,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,0.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,0.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,0.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,0.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,0.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,0.82,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,0.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,0.37,448,,facility
CT SCAN OF ABDOMEN WITHOUT CONTRAST,74150,CPT,0352,RC,,,,outpatient,,,5052,505.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,403,,,,,,,case rate,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,371,,,,,,,case rate,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,411,411,411,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,875,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1050,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,2667.46,2667.46,2667.46,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1522,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,1522,,facility
BLOOD PLATELET AGGREGATION,85576,CPT,305,RC,,,,outpatient,,,50,5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,22.16,22.16,22.16,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,70.56,70.56,70.56,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,24.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,52.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,26.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,22.16,22.16,22.16,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,24.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,26.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,46.41,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,25.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,24.91,448,,facility
B CELLS TOTAL COUNT,86355,CPT,302,RC,,,,outpatient,,,167,16.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,33.56,33.56,33.56,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,60.77,60.77,60.77,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,37.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,37.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,27.98,27.98,27.98,1 through 10,percent of total billed charges,,,33.6,,33.56,33.56,33.56,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,63.63,63.63,63.63,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,78.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,39.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,33.56,33.56,33.56,25,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,39.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,81.52,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,38.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,37.73,448,,facility
GENETIC SEQUENCING LOCALIZATION; INITIAL PROCEDURE,88365,CPT,0310,RC,,,,outpatient,,,203,20.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,163,163,163,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,167.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,169.34,169.34,266.11,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,340.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,172.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,252,252,252,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,107.35,107.35,339.75,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,172.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,226.07,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,166.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,163.06,448,,facility
ASPERGILLUS ANTIBODY,86606,CPT,302,RC,,,,outpatient,,,36,3.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,31.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.39,13.39,13.39,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.53,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,15.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,15.05,448,,facility
COLLECTION OF DONOR STEM CELLS FOR TRANSPLANTATION,38205,CPT,0815,RC,,,,inpatient,,,5342,534.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Short Stay Lesser of + Days Threshold 1.00 + Stoploss First Dollar + Reimbursement Rate 57.00 + Basic Per Diem + Fixed Rate 5000.00 + Fixed Amount 157464.00,,,,0,other,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,Short Stay Lesser of + Days Threshold 1.00 + Stoploss First Dollar + Reimbursement Rate 72.00 + Basic Per Diem + Fixed Rate 10000.00 + Fixed Amount 56687.00,,,,0,other,NTE Percentage + Reimbursement Rate 85.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,2035.3,2035.3,2035.3,1 through 10,percent of total billed charges,,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,47.3,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,facility
INJ HEPARIN SODIUM PER 1000U,J1644,HCPCS,636,RC,,,,outpatient,,,3,0.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,4,4,4,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,52.8,,7.18,3.82,24.86,36,percent of total billed charges,,,33.6,,3.02,2.57,10.58,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,4.2,2.69,8.82,20,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,50,,3.38,3.38,3.38,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,1.42,1.42,1.42,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",448,448,,facility
COMPLEMENT ANTIGEN,86160,CPT,302,RC,,,,outpatient,,,701,70.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.67,10.67,10.67,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,87.32,87.32,87.32,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,78.14,49.73,270.86,17,percent of total billed charges,,,33.6,,49.73,49.73,172.37,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,49.73,29.23,50.32,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,256.5,256.5,256.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.67,10.67,10.67,61,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.92,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12,448,,facility
UNLISTED MOLECULAR PATHOLOGY,81479,CPT,310,RC,,,,outpatient,,,1638,163.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,561.56,561.56,561.56,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,32.5,32.5,3071.5,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
SOCKET INSERT SYMES,L5654,HCPCS,274,RC,,,,outpatient,,,718,71.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,66,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,61,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,482.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,482.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,497.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,482.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1008.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,511.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,482.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,511.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,492.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,482.61,1008.65,,facility
CYTOGENETICS 100-300,88275,CPT,311,RC,,,,outpatient,,,907,90.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,45.53,45.53,45.53,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,51.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,51.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,52.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,1828.51,1828.51,1828.51,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,401.18,401.18,401.18,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,51.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,106.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,54.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,45.53,45.53,45.53,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,51.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,54.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,89.58,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,52.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,51.19,448,,facility
THROMBOPLASTIN TIME PARTIAL,85730,CPT,305,RC,,,,outpatient,,,27,2.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.35,5.35,5.35,44,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,17.28,17.28,226.56,25,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,208.86,15.93,208.86,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,186.91,11.69,202.13,44,percent of total billed charges,,,33.6,,118.94,9.07,237.89,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,118.94,9.07,120.01,25,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,12.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,177,13.5,177,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.35,5.35,5.35,310,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.99,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,6.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,6.01,448,,facility
CYTOGENETICS 100-300,88275,CPT,311,RC,,,,outpatient,,,792,79.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,45.53,45.53,45.53,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,51.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,51.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,52.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,1828.51,1828.51,1828.51,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,401.18,401.18,401.18,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,51.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,106.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,54.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,45.53,45.53,45.53,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,51.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,54.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,89.58,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,52.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,51.19,448,,facility
ASSAY OF TROPONIN QUANT,84484,CPT,301,RC,,,,outpatient,,,700,70,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.09,11.09,11.09,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,312,312,312,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,83.94,49.39,178.15,66,percent of total billed charges,,,33.6,,83.94,49.39,126.14,15,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,49.39,49.39,148.18,37,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,26.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,156,156,312,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,23.73,23.73,23.73,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.09,11.09,11.09,460,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.82,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.47,448,,facility
GENE ANALYSIS (TUMOR PROTEIN 53) TARGETED SEQUENCE ANALYSIS,81352,CPT,0310,RC,,,,outpatient,,,4511,451.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,329.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,329.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,339.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,1529.23,1529.23,1529.23,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,329.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,688.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,349.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,329.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,349.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,576.64,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,336.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,329.51,688.68,,facility
REMOVAL OF FOREIGN MATERIAL FROM SKIN; TISSUE; MUSCLE; AND BONE AT OPEN BROKEN AND/OR DISLOCATED BONE,11012,CPT,0450,RC,,,,outpatient,,,5072,507.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2779.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2779.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2863.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2779.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,5810.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2946.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2779.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2946.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2835.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,5810.16,,facility
ANTINUCLEAR ANTIBODIES,86038,CPT,302,RC,,,,outpatient,,,217,21.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.75,10.75,10.75,34,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,148.09,148.09,148.09,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,84.34,29.04,132.53,14,percent of total billed charges,,,33.6,,84.34,18.48,127.78,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,84.34,84.34,85.09,12,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,11.55,11.55,11.55,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.75,10.75,10.75,126,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.11,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.09,448,,facility
"INJ., KANJINTI, 10 MG",Q5117,HCPCS,636,RC,,,,outpatient,,,299,29.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,6879.99,6879.99,6879.99,39,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,60.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,60.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,62.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,60.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,126.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,64.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,60.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,64.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,74.58,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,61.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,60.52,448,,facility
SIMPLE REPAIR OF SURFACE WOUND OF SCALP; NECK; UNDERARMS; TRUNK; ARMS; OR LEGS; 2.6-7.5 CM,12002,CPT,0450,RC,,,,outpatient,,,1584,158.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,197.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,904.46,536.98,904.47,11,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,532.22,532.22,536.98,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,401.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,203.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,176.95,176.95,180.67,36,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,203.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,195.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,192.01,448,,facility
DETECT AGENT NOS DNA AMP,87798,CPT,306,RC,,,,outpatient,,,410,41,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,110.88,110.88,174.24,1 through 10,percent of total billed charges,,,33.6,,244.27,244.27,244.27,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,96.77,32.38,119.79,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,38.9,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
BLOOD GASES ANY COMBINATION,82803,CPT,301,RC,,,,outpatient,,,885,88.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,23.19,23.19,23.19,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,182.16,115.92,197,26,percent of total billed charges,,,33.6,,115.92,107.14,115.92,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,115.92,89.84,228.59,16,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,26.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,54.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,27.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,172.5,172.5,172.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,23.19,23.19,23.19,245,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,26.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,27.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,45.62,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,26.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,26.07,448,,facility
ASSAY OF PHENYTOIN TOTAL,80185,CPT,301,RC,,,,outpatient,,,165,16.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,70.22,70.22,70.22,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,44.69,44.69,44.69,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.79,11.79,11.79,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.63,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.25,448,,facility
COL CHROMOTOGRAPHY QUAL/QUAN,82542,CPT,301,RC,,,,outpatient,,,154,15.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,21.43,21.43,21.43,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,435.07,435.07,435.07,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,24.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,50.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,25.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,21.43,21.43,21.43,15,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,24.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,25.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.16,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,24.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,24.09,448,,facility
EXAM OF LUNG AIRWAYS AND SAMPLING OF LYMPH NODES USING AN ENDOSCOPE AND ULTRASOUND GUIDANCE; 3 OR MORE LYMPH NODES,31653,CPT,0750,RC,,,,outpatient,,,10460,1046,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,3568.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3568.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3675.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3568.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,7457.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3782.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,208.97,208.97,208.97,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3568.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3782.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9389,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,3639.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,9389,,facility
MANUAL ATTEMPT TO RESTORE BLOOD CIRCULATION AND BREATHING,92950,CPT,0480,RC,,,,outpatient,,,1708,170.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,273.22,273.22,273.22,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,206.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,206.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,212.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,206.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,431.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,219.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,206.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,219.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1463,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,210.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,206.65,1463,,facility
DNA ANTIBODY NATIVE,86225,CPT,302,RC,,,,outpatient,,,197,19.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.22,12.22,12.22,16,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,32.21,29.57,46.46,11,percent of total billed charges,,,33.6,,29.57,29.57,29.57,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,29.66,29.57,98.11,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,28.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.22,12.22,12.22,49,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.7,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.74,448,,facility
COMPLETE ULTRASOUND STUDY OF ARM AND LEG ARTERIES,93923,CPT,0921,RC,,,,outpatient,,,4044,404.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,206.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,206.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,212.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,206.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,431.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,219.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,206.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,219.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1227,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,210.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,206.65,1227,,facility
HEAVY METAL LEVEL,83018,CPT,0301,RC,,,,outpatient,,,499,49.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,21.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,45.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,23.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,21.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,23.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,47.46,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,22.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,21.96,448,,facility
SIMPLE REPAIR OF SURFACE WOUND OF FACE; EARS; EYELIDS; NOSE; LIPS; OR MOUTH; 5.1-7.5 CM,12014,CPT,0450,RC,,,,outpatient,,,1584,158.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,197.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,401.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,203.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,180.67,180.67,180.67,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,203.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,195.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,192.01,1173,,facility
FLOWCYTOMETRY/ TC 1 MARKER,88184,CPT,311,RC,,,,outpatient,,,759,75.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,315.62,315.62,343.05,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,546.56,546.56,731.52,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,343.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,343.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,353.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,286.94,286.94,384.05,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,343.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,716.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,363.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,179.34,179.34,179.34,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,63.07,63.07,165.15,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,343.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,363.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,377,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,349.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,343.05,716.97,,facility
COAGULATION TIME ACTIVATED,85347,CPT,305,RC,,,,outpatient,,,118,11.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,57.12,38.17,224.4,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,8.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.81,3.81,3.81,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.21,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,4.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,4.28,448,,facility
ASSAY OF LIPASE,83690,CPT,301,RC,,,,outpatient,,,36,3.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,6.13,6.13,6.13,44,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,81.65,42.15,81.65,67,percent of total billed charges,,,33.6,,48.05,19.01,48.05,11,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,48.05,37.29,48.05,74,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,14.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,7.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,18,18,71.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,6.13,6.13,6.13,696,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,7.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.89,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,7.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,6.89,448,,facility
INSERTION OF DEVICE INTO VAGINA FOR RADIATION THERAPY,57156,CPT,0361,RC,,,,outpatient,,,1811,181.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,269.01,269.01,291.64,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,291.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,291.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,300.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,291.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,609.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,309.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,291.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,309.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2440,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,297.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,291.64,2440,,facility
TOXOPLASMA ANTIBODY,86777,CPT,302,RC,,,,outpatient,,,272,27.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.8,12.8,12.8,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,64.42,64.42,64.42,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,30.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.8,12.8,12.8,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,31.1,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.39,448,,facility
MOPATH PROCEDURE LEVEL 2,81401,CPT,310,RC,,,,outpatient,,,1117,111.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,121.86,121.86,121.86,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,137,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,137,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,141.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,137,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,286.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,145.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,137,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,145.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,239.75,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,139.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,137,448,,facility
ANCA SCREEN EACH ANTIBODY,86036,CPT,302,RC,,,,outpatient,,,215,21.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.09,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.05,448,,facility
MPSV4 VACCINE SUBQ,90733,CPT,636,RC,,,,outpatient,,,681,68.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
JAK2 GENE TRGT SEQUENCE ALYS,81279,CPT,310,RC,,,,outpatient,,,400,40,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,185.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,185.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,190.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,185.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,387.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,196.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,164.73,164.73,164.73,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,185.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,196.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,324.1,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,188.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,185.2,448,,facility
T CELL ABSOLUTE COUNT,86361,CPT,302,RC,,,,outpatient,,,381,38.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,23.82,23.82,23.82,46,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,160.48,160.19,463.15,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,143.62,91.39,143.62,24,percent of total billed charges,,,33.6,,143.62,91.39,414.48,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,91.39,91.39,92.04,15,percent of total billed charges,,,34.6,,284.95,284.95,284.95,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,26.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,55.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,28.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,136,135.75,136,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,23.82,23.82,23.82,197,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,26.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,28.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,57.86,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,27.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,26.78,448,,facility
NUCLEAR ANTIGEN ANTIBODY,86235,CPT,302,RC,,,,outpatient,,,232,23.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13,12.5,15.95,11,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,54.91,4.37,90.29,43,percent of total billed charges,,,33.6,,4.37,4.37,53.09,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,22.18,4.24,83.33,13,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,37.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.95,13,15.95,54,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.75,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.93,448,,facility
BELOW KNEE SUS/SEAL SLEEVE,L5685,HCPCS,274,RC,,,,outpatient,,,236,23.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,66,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,61,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,158.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,158.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,163.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,158.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,331.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,168.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,158.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,168.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,161.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,158.53,331.33,,facility
VINCRISTINE SULFATE 1 MG INJ,J9370,HCPCS,636,RC,,,,outpatient,,,321,32.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,410.88,410.88,410.88,26,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,52.8,,41.34,41.34,338.98,14,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,21.73,21.73,21.73,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",448,448,,facility
DNA/RNA AMPLIFIED PROBE,87150,CPT,306,RC,,,,outpatient,,,1723,172.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
ANTIEPILEPTICS NOS 7/MORE,80341,CPT,301,RC,,,,outpatient,,,40,4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
ECHOGRAP TRANS R PROS STUDY,76873,CPT,402,RC,,,,outpatient,,,2485,248.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,465,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,465,,facility
FETAL CHRMOML ANEUPLOIDY,81420,CPT,310,RC,,,,outpatient,,,1019,101.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,675.16,675.16,675.16,181,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,1288.32,668.25,1288.32,15,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,1187.67,1187.67,1477.36,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,759.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,759.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,781.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,1062.86,676.37,1062.86,1 through 10,percent of total billed charges,,,33.6,,675.16,675.16,676.37,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,676.37,484.18,682.41,19,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,759.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1586.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,804.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,1006.5,1006.5,1006.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,593.47,593.47,593.47,1 through 10,percent of total billed charges,,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,675.16,675.16,675.16,133,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,759.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,804.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1328.34,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,774.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1586.41,,facility
BIOPSY OF SMALL BOWEL POUCH USING AN ENDOSCOPE,44386,CPT,0750,RC,,,,outpatient,,,3740,374,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,399.97,399.97,799.94,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,890.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,890.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,916.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,1392.72,1392.72,1392.72,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,890.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1860.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,943.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,890.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,943.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3821,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,907.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3821,,facility
SC STD MYOBACTERIA PROP METH,87190,CPT,306,RC,,,,outpatient,,,87,8.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,7.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,15.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,7.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,7.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,7.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.79,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,7.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,7.31,448,,facility
BLOOD TYPING FOR RH (D) ANTIGEN,86901,CPT,0302,RC,,,,outpatient,,,264,26.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,2.66,2.66,62.15,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,155.76,19.47,155.76,14,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,88.7,17.42,150.74,116,percent of total billed charges,,,33.6,,88.7,17.42,88.7,44,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,88.7,11.09,100.58,78,percent of total billed charges,,,34.6,,97.68,95.83,100.58,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,74.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,132,16.5,132,13,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,55.44,6.93,55.44,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,2.66,2.66,2.66,1 through 10,percent of total billed charges,,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,2.66,2.66,2.66,829,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.46,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,36.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,6.46,448,,facility
CHROMOGENIC SUBSTRATE ASSAY,85130,CPT,305,RC,,,,outpatient,,,270,27,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.58,10.58,10.58,11,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,571.12,571.12,571.12,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,277.2,277.2,277.2,1 through 10,percent of total billed charges,,,33.6,,176.4,176.4,176.4,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,24.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.58,10.58,10.58,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.69,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.89,448,,facility
X-RAY OF UPPER SPINE; 4-5 VIEWS,72050,CPT,0320,RC,,,,outpatient,,,1619,161.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,1036.16,1036.16,1036.16,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,854.83,854.83,854.83,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,543.98,543.98,543.98,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,448,,facility
TOXOPLASMA ANTIBODY,86777,CPT,302,RC,,,,outpatient,,,235,23.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.8,12.8,12.8,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,64.42,64.42,64.42,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,30.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.8,12.8,12.8,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,31.1,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.39,448,,facility
PROTEIN WESTERN BLOT TEST,84182,CPT,301,RC,,,,outpatient,,,726,72.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,217.54,217.54,217.54,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,29.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,61.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,30.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,25.98,25.98,25.98,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,29.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,30.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,51.12,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,29.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,29.21,448,,facility
CHEMO IV INFUSION ADDL HR,96415,CPT,335,RC,,,,outpatient,,,832,83.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,62.45,58.46,175.39,429,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,532.48,490.88,1597.44,87,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,1472.64,1472.64,1472.64,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,68.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,68.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,70.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,878.59,282.05,1317.89,86,percent of total billed charges,,,33.6,,279.55,279.55,838.66,33,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,279.55,279.55,559.1,50,percent of total billed charges,,,34.6,,316.99,316.99,316.99,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,68.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,144.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,73.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,416,416,416,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,174.72,174.72,174.72,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,64.84,63.38,190.14,237,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,68.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,73.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1603,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,70.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,68.91,1603,,facility
TEST TO MEASURE EXHALED AIR AND CARBON DIOXIDE FOR EVALUATION OF LUNG FUNCTION,94681,CPT,0460,RC,,,,outpatient,,,824,82.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,357.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,357.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,367.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,357.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,746.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,378.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,32.16,32.16,32.16,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,357.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,378.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,611,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,364.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,357.13,746.4,,facility
DRUG ASSAY CYCLOSPORINE,80158,CPT,301,RC,,,,outpatient,,,752,75.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,254.93,70.9,254.93,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,37.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.06,16.06,16.06,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.99,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.05,448,,facility
APPLICATION OF ON-BODY INJECTOR FOR UNDER SKIN INJECTION,96377,CPT,0260,RC,,,,outpatient,,,132,13.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,41.34,40.48,44.82,14,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,44.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,44.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,46.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,44.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,93.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,47.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,29.94,29.94,29.94,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,44.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,47.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,427,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,45.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,44.82,1173,,facility
IMMUNOASSAY QUANT NOS NONAB,83520,CPT,301,RC,,,,outpatient,,,1056,105.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,36,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,66.08,66.08,66.08,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,41.18,24.82,318.38,1 through 10,percent of total billed charges,,,33.6,,37.63,37.63,96.43,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,33.6,23.18,176.4,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,36.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,87,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.22,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.27,448,,facility
AFO RIG ANT TIB TCF/= CUSTOM,L1932,HCPCS,274,RC,,,,outpatient,,,1637,163.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,66,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,61,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1102.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1102.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1135.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1102.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,2304.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1168.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1102.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1168.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,1124.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,1102.55,2304.33,,facility
CALCIUM LEVEL; IONIZED,82330,CPT,0301,RC,,,,outpatient,,,190,19,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.17,12.17,12.17,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,85.31,18.14,138.18,19,percent of total billed charges,,,33.6,,81.31,81.31,81.31,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,64.41,18.14,81.31,24,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,28.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,50.82,50.82,50.82,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.17,12.17,12.17,185,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.54,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.68,448,,facility
MICRODISSECTION MANUAL,88381,CPT,310,RC,,,,outpatient,,,1392,139.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,93.74,93.74,93.74,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,21.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,44.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,21.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,172.62,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,21.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,21.51,448,,facility
DRUG SCREENING METHADONE,80358,CPT,301,RC,,,,outpatient,,,600,60,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
UNLISTED MOLECULAR PATHOLOGY,81479,CPT,310,RC,,,,outpatient,,,65,6.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,561.56,561.56,561.56,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,32.5,32.5,3071.5,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
OXFORD W/ SUPINAT/PRONATOR C,L3202,HCPCS,274,RC,,,,outpatient,,,122,12.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,66,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,61,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,facility
REMOVAL OF NONCANCER SKIN GROWTH OF FACE; EARS; EYELIDS; NOSE; LIPS; OR MOUTH; MORE THAN 4.0 CM,11446,CPT,0761,RC,,,,outpatient,,,3201,320.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2779.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2779.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2863.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2779.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,5810.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2946.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,2548.7,2548.7,2548.7,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2779.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2946.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,2835.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,5810.16,,facility
MONONUCLEAR CELL ANTIGEN,86356,CPT,302,RC,,,,outpatient,,,518,51.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,23.82,23.82,23.82,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,138.06,138.06,552.24,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,464.64,464.64,464.64,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,26.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,55.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,28.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,23.82,23.82,23.82,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,26.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,28.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,57.86,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,27.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,26.78,448,,facility
X-RAY OF MIDDLE SPINE; 2 VIEWS,72070,CPT,0320,RC,,,,outpatient,,,1055,105.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,622.45,622.45,622.45,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,354.48,354.48,602.4,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,354.48,354.48,354.48,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,18.87,18.87,19.41,15,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,448,,facility
HERPES SIMPLEX TYPE 2 TEST,86696,CPT,302,RC,,,,outpatient,,,276,27.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,17.21,17.21,17.21,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,20.59,20.59,42.71,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,13.1,13.1,13.1,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,40.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,20.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,17.21,17.21,17.21,12,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,20.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,41.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,19.35,448,,facility
IMMUNOASSAY INFECTIOUS AGENT,86317,CPT,302,RC,,,,outpatient,,,307,30.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.33,13.33,13.33,86,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,59,59,59,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,52.8,26.54,52.8,41,percent of total billed charges,,,33.6,,52.8,33.6,52.8,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,33.6,33.6,33.73,52,percent of total billed charges,,,34.6,,218.53,218.53,218.53,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,31.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,50,50,50,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.33,13.33,13.33,209,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.38,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,15.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.99,448,,facility
MEASUREMENT OF COLD AGGLUTININ (PROTEIN) TO SCREEN FOR INFECTION OR DISEASE,86156,CPT,0302,RC,,,,outpatient,,,413,41.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,250.8,250.8,271.22,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,16.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.47,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,8.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,8.07,448,,facility
CMV ANTIBODY,86644,CPT,302,RC,,,,outpatient,,,50,5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.8,12.8,12.8,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,30.08,30.08,85.12,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,70.22,44.69,76.56,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,49.24,48.72,49.24,1 through 10,percent of total billed charges,,,34.6,,48.28,17.91,50.67,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,30.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.8,12.8,12.8,11,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,31.1,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.39,448,,facility
REMOVAL OF IUD,58301,CPT,0761,RC,,,,outpatient,,,783,78.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,266.9,266.9,266.9,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,291.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,291.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,300.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,291.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,609.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,309.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,291.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,309.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,297.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,291.64,1173,,facility
FINE NEEDLE ASPIRATION AND/OR BIOPSY OF LOWER LARGE BOWEL WITH ULTRASOUND GUIDANCE USING A FLEXIBLE ENDOSCOPE,45342,CPT,0750,RC,,,,outpatient,,,3278,327.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1179.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,1111.24,1111.24,1111.24,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,2393.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1213.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1213.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3821,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1168.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3821,,facility
CHEMOTHERAPY ADMINISTRATION; INTRAVENOUS INFUSION TECHNIQUE; INITIATION OF INFUSION IN THE OFFICE/OTHER OUTPATIENT SETTING USING OFFICE/OTHER OUTPATIENT SETTING PUMP/SUPPLIES; WITH CONTINUATION OF THE INFUSION IN THE COMMUNITY SETTING (E.G.; HOME; DOMICILIARY; REST HOME OR ASSISTED LIVING) USING A PORTABLE PUMP PROVIDED BY THE OFFICE/OTHER OUTPATIENT SETTING; INCLUDES FOLLOW UP OFFICE/OTHER OUTPATIENT VISIT AT THE CONCLUSION OF THE INFUSION,G0498,HCPCS,0335,RC,,,,outpatient,,,1288,128.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,291.03,291.03,315.51,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,824.32,824.32,824.32,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,316.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,316.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,325.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,316.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,660.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,335.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,316.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,335.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1603,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,322.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,316.12,1603,,facility
ERIBULIN MESYLATE INJECTION,J9179,HCPCS,636,RC,,,,outpatient,,,592,59.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,59.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,59.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,61.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,2450.45,2450.45,2450.45,13,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,59.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,125.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,63.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,59.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,63.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,286.64,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,61.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,59.98,448,,facility
ENDO KNEE-SHIN PNEUM/SWG PHA,L5830,HCPCS,274,RC,,,,outpatient,,,3748,374.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,66,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,61,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Stoploss First Dollar + Reimbursement Rate 50.00 + Percent Of Charge + Reimbursement Rate 0.00 + Fixed Amount 3149.00,,,,0,other,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,Stoploss First Dollar + Reimbursement Rate 50.00 + Percent Of Charge + Reimbursement Rate 0.00 + Fixed Amount 3149.00,,,,0,other,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,2549.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2549.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2626.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2549.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,5328.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2702.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2549.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2702.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,2600.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,2549.61,5328.68,,facility
BACTERIAL CULTURE FOR AEROBIC ISOLATES,87077,CPT,0306,RC,,,,outpatient,,,172,17.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,7.19,7.19,7.19,67,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,101.48,25.96,101.48,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,90.82,57.79,154.46,34,percent of total billed charges,,,33.6,,57.79,53.5,90.82,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,57.79,14.92,58.31,28,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,16.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,86,86,172,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,36.12,36.12,36.12,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,7.19,7.19,7.19,240,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.45,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,8.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,8.08,448,,facility
KNEE-SHIN EXT JNTS FLD SWG E,L5726,HCPCS,274,RC,,,,outpatient,,,4175,417.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,66,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,61,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Stoploss First Dollar + Reimbursement Rate 50.00 + Percent Of Charge + Reimbursement Rate 0.00 + Fixed Amount 3149.00,,,,0,other,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,Stoploss First Dollar + Reimbursement Rate 50.00 + Percent Of Charge + Reimbursement Rate 0.00 + Fixed Amount 3149.00,,,,0,other,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,2839.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2839.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2924.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2839.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,5934.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3009.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2839.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3009.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,2896.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,2839.54,5934.64,,facility
IMMUNOASSAY QUANT NOS NONAB,83520,CPT,301,RC,,,,outpatient,,,463,46.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,36,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,66.08,66.08,66.08,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,41.18,24.82,318.38,1 through 10,percent of total billed charges,,,33.6,,37.63,37.63,96.43,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,33.6,23.18,176.4,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,36.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,87,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.22,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.27,448,,facility
EPSTEIN-BARR ANTIBODY,86663,CPT,302,RC,,,,outpatient,,,213,21.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.35,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.12,448,,facility
BLOOD PLATELET AGGREGATION,85576,CPT,305,RC,,,,outpatient,,,130,13,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,22.16,22.16,22.16,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,70.56,70.56,70.56,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,24.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,52.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,26.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,22.16,22.16,22.16,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,24.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,26.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,46.41,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,25.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,24.91,448,,facility
INSULIN ANTIBODIES,86337,CPT,302,RC,,,,outpatient,,,90,9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.04,19.04,19.04,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,34.85,34.85,34.85,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,21.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,44.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.04,19.04,19.04,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,21.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,46.25,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,21.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,21.41,448,,facility
MITOCHONDRIAL ANTIBODY EACH,86381,CPT,302,RC,,,,outpatient,,,121,12.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,22.64,22.64,22.64,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,45.41,16.13,249.13,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,28.9,28.9,28.9,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,25.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,53.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,26.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,22.64,22.64,22.64,19,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,25.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,26.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,44.54,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,25.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,25.45,448,,facility
"INJ., CEMIPLIMAB-RWLC, 1 MG",J9119,HCPCS,636,RC,,,,outpatient,,,120,12,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,29.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,29.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,62.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,31.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,29.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,31.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,60.65,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,30.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,29.67,448,,facility
PROGRAMMING OF DUAL LEAD PACEMAKER SYSTEM,93280,CPT,0480,RC,,,,outpatient,,,214,21.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,32.72,32.72,35.71,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,35.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,112.99,72.55,112.99,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,71.9,71.9,71.9,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,74.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,33.44,33.44,33.44,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1463,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,36.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.71,1463,,facility
BILIRUBIN DIRECT,82248,CPT,301,RC,,,,outpatient,,,33,3.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.47,4.47,4.47,154,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,19.47,19.47,160.48,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,17.42,17.42,155.31,44,percent of total billed charges,,,33.6,,11.09,11.09,143.62,18,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,91.39,11.09,91.39,51,percent of total billed charges,,,34.6,,103.63,103.63,190.4,1 through 10,percent of total billed charges,,,45,,4.47,4.47,4.47,1 through 10,percent of total billed charges,,5.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,10.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,16.5,16.5,16.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,6.93,6.93,6.93,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.47,4.47,4.47,656,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.02,448,,facility
MICRODISSECTION MANUAL,88381,CPT,310,RC,,,,outpatient,,,600,60,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,93.74,93.74,93.74,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,21.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,44.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,21.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,172.62,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,21.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,21.51,448,,facility
DRUG ASSAY INFLIXIMAB,80230,CPT,301,RC,,,,outpatient,,,329,32.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,39.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,38.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,80.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,40.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,38.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,40.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,67.5,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,39.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,38.57,448,,facility
FUNGAL CULTURE (MOLD OR YEAST) OF SKIN; HAIR; OR NAIL,87101,CPT,0306,RC,,,,outpatient,,,616,61.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,6.86,6.86,6.86,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,43.66,43.66,43.66,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,206.98,206.98,206.98,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,7.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,16.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,6.86,6.86,6.86,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,7.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.64,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,7.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,7.71,448,,facility
T CELLS TOTAL COUNT,86359,CPT,302,RC,,,,outpatient,,,272,27.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,33.56,33.56,33.56,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,37.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,37.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,82.68,82.68,82.68,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,78.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,39.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,33.56,33.56,33.56,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,39.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,81.52,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,38.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,37.73,448,,facility
BK MOLD SOCKET SACH FT ENDO,L5301,HCPCS,274,RC,,,,outpatient,,,5009,500.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,66,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,61,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Stoploss First Dollar + Reimbursement Rate 50.00 + Percent Of Charge + Reimbursement Rate 0.00 + Fixed Amount 3149.00,,,,0,other,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,Stoploss First Dollar + Reimbursement Rate 50.00 + Percent Of Charge + Reimbursement Rate 0.00 + Fixed Amount 3149.00,,,,0,other,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,3376.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3376.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3477.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3376.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,7056.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3578.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3376.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3578.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,3443.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,3376.36,7056.59,,facility
PROGESTERONE (REPRODUCTIVE HORMONE) LEVEL,84144,CPT,0301,RC,,,,outpatient,,,70,7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,18.55,18.55,18.55,24,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,41.3,41.3,41.3,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,36.96,23.52,222.29,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,23.52,23.52,141.46,29,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,20.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,43.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,18.55,18.55,18.55,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,20.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,45.08,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,21.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,20.86,448,,facility
DETECTION TEST BY NUCLEIC ACID FOR MULTIPLE TYPES OF RESPIRATORY VIRUS; MULTIPLE TYPES OR SUBTYPES; 3-5 TARGETS,87631,CPT,0306,RC,,,,outpatient,,,211,21.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,126.87,126.87,126.87,66,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,142.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,142.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,146.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,71.53,71.53,138.75,1 through 10,percent of total billed charges,,,33.6,,71.53,71.53,71.53,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,142.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,298.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,151.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,126.87,126.87,126.87,143,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,142.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,151.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,277.17,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,145.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,142.63,448,,facility
X-RAY OF UPPER ARM; MINIMUM OF 2 VIEWS,73060,CPT,0320,RC,,,,outpatient,,,774,77.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,85.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,174.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.68,19.68,20.25,30,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,84.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,83.29,448,,facility
ASSAY OF MYOGLOBIN,83874,CPT,301,RC,,,,outpatient,,,57,5.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.49,11.49,11.49,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.91,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.92,448,,facility
SLEEP STUDY IN SLEEP LAB (YOUNGER THAN 6 YEARS),95782,CPT,0920,RC,,,,outpatient,,,11834,1183.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,892.66,758.08,967.76,73,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,8709.76,8709.76,8709.76,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,8029.31,8029.31,8029.31,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,821.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,821.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,846.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,7185.55,7185.55,7185.55,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,4011.73,4011.73,4572.62,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,821.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1717.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,871.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,688.53,688.53,714.45,66,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,821.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,871.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,422,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,838.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,422,1717.69,,facility
APPL MODALITY 1+ESTIM EA 15,97032,CPT,420,RC,,,,outpatient,,,255,25.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,51.96,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,89.84,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,80,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,29.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,422,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.98,448,,facility
ADMINISTRATION OF NON-HORMONAL ANTI-NEOPLASTIC CHEMOTHERAPY UNDER SKIN OR INTO MUSCLE,96401,CPT,0331,RC,,,,outpatient,,,364,36.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,62.45,62.45,62.45,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,232.96,232.96,232.96,11,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,214.76,214.76,214.76,11,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,68.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,68.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,70.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,192.19,192.19,384.38,56,percent of total billed charges,,,33.6,,384.38,384.38,384.38,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,122.3,122.3,244.61,32,percent of total billed charges,,,34.6,,132.13,132.13,138.68,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,68.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,144.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,73.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,64.84,63.38,190.14,122,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,68.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,73.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1603,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,70.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,68.91,1603,,facility
DETECT AGENT NOS DNA AMP,87798,CPT,306,RC,,,,outpatient,,,186,18.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,110.88,110.88,174.24,1 through 10,percent of total billed charges,,,33.6,,244.27,244.27,244.27,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,96.77,32.38,119.79,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,38.9,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
DIAGNOSTIC EXAM OF VOICE BOX USING A FLEXIBLE ENDOSCOPE,31575,CPT,0450,RC,,,,outpatient,,,884,88.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,170.34,159.46,170.34,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,191.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,191.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,196.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,191.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,399.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,202.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,172.88,172.88,179.75,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,191.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,202.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,194.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,191.04,1311,,facility
"BRACHYTX, NS, NON-HDRIR-192",C1719,HCPCS,278,RC,,,,outpatient,,,12996,1299.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,66,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,61,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Stoploss First Dollar + Reimbursement Rate 50.00 + Percent Of Charge + Reimbursement Rate 0.00 + Fixed Amount 3149.00,,,,0,other,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,Stoploss First Dollar + Reimbursement Rate 50.00 + Percent Of Charge + Reimbursement Rate 0.00 + Fixed Amount 3149.00,,,,0,other,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,904.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,904.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,931.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,904.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1889.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,958.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,904.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,958.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,922.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,904.25,1889.88,,facility
IMFLUOR EA ADDL 1ANTB STN PX,88350,CPT,310,RC,,,,outpatient,,,261,26.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,26.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,55.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,28.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,26.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,28.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,76.23,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,27.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,26.49,448,,facility
NFCT AGT GNTYP ALYS HEP C,87902,CPT,306,RC,,,,outpatient,,,1372,137.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,229,229,229,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,257.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,257.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,265.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,257.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,538.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,272.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,229,229,229,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,257.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,272.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,556.22,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,262.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,257.45,556.22,,facility
FIBRINOGEN (FACTOR 1) ACTIVITY MEASUREMENT,85384,CPT,0305,RC,,,,outpatient,,,459,45.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,8.65,8.65,8.65,24,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,35.38,22.51,262.09,12,percent of total billed charges,,,33.6,,35.38,22.51,154.22,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,154.22,154.22,311.2,1 through 10,percent of total billed charges,,,34.6,,169.83,169.83,169.83,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,9.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,20.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,33.5,33.5,33.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,8.65,8.65,8.65,96,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,9.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.36,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,9.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,9.72,448,,facility
N.GONORRHOEAE DNA AMP PROB,87591,CPT,306,RC,,,,outpatient,,,1293,129.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,442,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,50.15,20.65,65.49,11,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,228.48,228.48,228.48,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,37.3,18.48,58.61,60,percent of total billed charges,,,33.6,,37.3,11.76,63.38,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,28.82,11.76,37.3,69,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,42.5,17.5,55.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,23.31,23.31,23.31,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,31.21,31.21,31.21,1 through 10,percent of total billed charges,,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,796,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
VAR VACCINE LIVE SUBQ,90716,CPT,636,RC,,,,outpatient,,,523,52.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
TESTING FOR PRESENCE OF DRUG; READ BY DIRECT OBSERVATION,80305,CPT,0301,RC,,,,outpatient,,,37,3.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,26.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,23.56,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.6,448,,facility
QUANTITATIVE ASSAY DRUG,80299,CPT,301,RC,,,,outpatient,,,646,64.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,13,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,174.64,174.64,174.64,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,171.6,171.6,171.6,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,374.52,374.52,374.52,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.62,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.64,448,,facility
CELL FUNCTION ASSAY W/STIM,86352,CPT,302,RC,,,,outpatient,,,506,50.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,135.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,135.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,139.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,210.52,210.52,210.52,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,135.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,283.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,144.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,120.85,120.85,120.85,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,135.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,144.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,293.53,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,138.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,135.86,448,,facility
ENDO KNEE-SHIN FLUID SWG/STA,L5828,HCPCS,274,RC,,,,outpatient,,,5129,512.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,66,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,61,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Stoploss First Dollar + Reimbursement Rate 50.00 + Percent Of Charge + Reimbursement Rate 0.00 + Fixed Amount 3149.00,,,,0,other,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,Stoploss First Dollar + Reimbursement Rate 50.00 + Percent Of Charge + Reimbursement Rate 0.00 + Fixed Amount 3149.00,,,,0,other,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,3457.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3457.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3560.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3457.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,7225.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3664.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3457.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3664.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,3526.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,3457.19,7225.53,,facility
VITAMIN D-3 LEVEL,82306,CPT,0301,RC,,,,outpatient,,,677,67.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,26.33,26.33,26.33,345,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,123.9,123.9,399.43,17,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,110.88,70.56,357.46,103,percent of total billed charges,,,33.6,,71.19,70.56,227.47,16,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,70.56,70.56,227.47,175,percent of total billed charges,,,34.6,,257.94,257.94,257.94,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,29.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,61.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,31.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,105,105,338.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,142.17,44.1,142.17,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,26.33,26.33,26.33,1001,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,29.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,31.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,63.96,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,30.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,29.6,448,,facility
MOLDED INNER BOOT,L2280,HCPCS,274,RC,,,,outpatient,,,774,77.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,66,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,61,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,520.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,520.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,535.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,520.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1087.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,551.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,520.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,551.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,530.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,520.33,1087.49,,facility
SMOKING AND TOBACCO USE INTENSIVE COUNSELING; 4-10 MINUTES,99406,CPT,0942,RC,,,,outpatient,,,166,16.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,26.14,26.14,35.86,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,74.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,38.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.19,10.19,10.49,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,38.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,232,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,36.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.86,448,,facility
PROGRAMMING OF DUAL LEAD IMPLANTABLE DEFIBRILLATOR SYSTEM,93283,CPT,0480,RC,,,,outpatient,,,242,24.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,32.72,32.72,32.72,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,177.92,154.88,177.92,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,35.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,146.78,146.78,146.78,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,93.41,93.41,93.41,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,74.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,33.71,5.1,35.52,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1463,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,36.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.71,1463,,facility
DETECT AGENT NOS DNA AMP,87798,CPT,306,RC,,,,outpatient,,,380,38,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,110.88,110.88,174.24,1 through 10,percent of total billed charges,,,33.6,,244.27,244.27,244.27,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,96.77,32.38,119.79,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,38.9,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
THROMBIN TIME PLASMA,85670,CPT,305,RC,,,,outpatient,,,80,8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,12.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.46,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.77,448,,facility
MOPATH PROCEDURE LEVEL 2,81401,CPT,310,RC,,,,outpatient,,,1654,165.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,121.86,121.86,121.86,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,137,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,137,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,141.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,137,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,286.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,145.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,137,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,145.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,239.75,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,139.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,137,448,,facility
IGH VARI REGIONAL MUTATION,81263,CPT,310,RC,,,,outpatient,,,2781,278.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,294.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,294.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,303.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,294.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,615.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,312.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,294.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,312.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,636.3,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,300.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,294.52,636.3,,facility
X-RAY OF HIP; 2-3 VIEWS,73502,CPT,0320,RC,,,,outpatient,,,929,92.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,85.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,174.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,29.93,29.93,30.8,16,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,84.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,83.29,448,,facility
FLUORESCENT ANTIBODY SCREEN,86255,CPT,302,RC,,,,outpatient,,,424,42.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.72,10.72,10.72,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,45.41,28.9,1068.67,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,28.9,28.9,28.9,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.72,10.72,10.72,19,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.04,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.05,448,,facility
COMPLETE ULTRASOUND OF ABDOMEN AND PELVIS ARTERY AND VEIN BLOOD FLOW,93975,CPT,0921,RC,,,,outpatient,,,3746,374.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,212.09,212.09,229.93,90,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,2397.44,2397.44,2397.44,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,2210.14,2210.14,2210.14,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,235.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,1258.66,1258.66,1977.89,1 through 10,percent of total billed charges,,,33.6,,1258.66,1258.66,1977.89,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,1258.66,1258.66,1269.89,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,477.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,242.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,1873,1873,1873,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,166.94,166.94,175.13,87,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,242.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1227,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,232.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,228.36,1227,,facility
HEAVY METAL QUAN EACH NES,83018,CPT,301,RC,,,,outpatient,,,395,39.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,21.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,45.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,23.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,21.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,23.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,47.46,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,22.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,21.96,448,,facility
CAST SUP SHT ARM ADULT FBRGL,Q4010,HCPCS,270,RC,,,,outpatient,,,61,6.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,24.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,51.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,26.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,24.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,26.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,25.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,24.8,448,,facility
ADMINISTRATION OF CHEMOTHERAPY INTO VEIN USING PUSH TECHNIQUE,96409,CPT,0331,RC,,,,outpatient,,,690,69,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,291.03,272.45,297.44,186,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,498.56,498.56,498.56,20,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,459.61,459.61,459.61,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,316.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,316.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,325.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,411.31,411.31,411.31,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,261.74,233.91,261.74,19,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,316.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,660.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,335.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,345,345,345,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,295.37,295.37,297.44,103,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,316.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,335.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1603,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,322.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,316.12,1603,,facility
CYTOGENETICS DNA PROBE,88271,CPT,311,RC,,,,outpatient,,,276,27.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.05,19.05,19.05,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,1274.11,1274.11,1274.11,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,477.79,477.79,477.79,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,21.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,44.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.05,19.05,19.05,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,21.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,46.27,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,21.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,21.42,448,,facility
ESTABLISHED PATIENT PERIODIC PREVENTIVE MEDICINE EXAMINATION (5-11 YEARS),99393,CPT,0770,RC,,,,outpatient,,,462,46.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,63.32,63.32,63.32,52,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,0.22,0.22,43.38,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
ALPHA-1-ANTITRYPSIN (PROTEIN) BLOOD TEST; PHENOTYPE,82104,CPT,0301,RC,,,,outpatient,,,10,1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10,10,12.86,11,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,16.46,16.46,25.87,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,3.36,3.36,3.36,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,30.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10,10,12.86,42,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,31.26,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.46,448,,facility
BIOPSY OF GROWTH OF EXTERNAL FEMALE GENITALS; FIRST GROWTH,56605,CPT,0761,RC,,,,outpatient,,,2091,209.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,881.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,881.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,907.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,881.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1842.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,934.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,881.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,934.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,899.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1842.34,,facility
TESTING FOR PRESENCE OF DRUG; BY CHEMISTRY ANALYZERS,80307,CPT,0301,RC,,,,outpatient,,,301,30.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,55.27,55.27,55.27,34,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,62.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,62.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,171.87,131.38,223.26,14,percent of total billed charges,,,33.6,,206.45,131.38,223.26,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,131.38,102.04,131.38,13,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,62.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,129.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,65.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,55.27,55.27,55.27,332,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,62.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,65.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,125.7,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,63.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,62.14,448,,facility
INJ PEMBROLIZUMAB,J9271,HCPCS,636,RC,,,,outpatient,,,0.01,,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,28800,28800,28800,1000,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,60.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,60.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,62.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,23760,23760,23760,4800,percent of total billed charges,,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,60.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,126.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,64.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,60.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,64.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,123.84,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,61.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,60.65,448,,facility
"INJECTION, FULVESTRANT",J9395,HCPCS,636,RC,,,,outpatient,,,400,40,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.32,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",137.25,137.25,137.25,20,other,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",14.32,448,,facility
UNLISTED MOLECULAR PATHOLOGY,81479,CPT,310,RC,,,,outpatient,,,1224,122.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,561.56,561.56,561.56,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,32.5,32.5,3071.5,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
X-RAY FOR BONE LENGTH ASSESSMENT,77073,CPT,0320,RC,,,,outpatient,,,1198,119.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,448,,facility
DETECTION TEST BY NUCLEIC ACID FOR CYTOMEGALOVIRUS; QUANTIFICATION,87497,CPT,0306,RC,,,,outpatient,,,1011,101.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,38.11,38.11,38.11,50,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,44.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,385.19,152.4,747.39,1 through 10,percent of total billed charges,,,33.6,,339.7,339.7,533.81,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,385.19,342.73,385.19,14,percent of total billed charges,,,34.6,,385.19,366.99,385.19,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,89.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,45.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,212.31,212.31,212.31,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,38.11,38.11,38.11,203,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,45.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,92.54,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,43.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,42.84,448,,facility
"INJ., COSYNTROPIN, 0.25 MG",J0834,HCPCS,636,RC,,,,outpatient,,,145,14.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,2864.64,2864.64,2864.64,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",448,448,,facility
TRIM NAIL(S) ANY NUMBER,11719,CPT,450,RC,,,,outpatient,,,172,17.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,56.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,56.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,58.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,56.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,118,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,59.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,56.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,59.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,57.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,56.46,448,,facility
RHEUMATOID FACTOR QUANT,86431,CPT,302,RC,,,,outpatient,,,106,10.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.04,5.04,5.04,26,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,33.63,33.63,33.63,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,30.1,19.05,30.1,1 through 10,percent of total billed charges,,,33.6,,19.15,19.15,30.1,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,19.15,19.15,19.24,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,11.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.04,5.04,5.04,75,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.25,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.67,448,,facility
PLATELET ANTIBODIES,86022,CPT,302,RC,,,,outpatient,,,592,59.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.34,16.34,16.34,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,39.69,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.37,448,,facility
ASSAY OF SIALIC ACID,84275,CPT,301,RC,,,,outpatient,,,380,38,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,28.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.03,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.44,448,,facility
FLOWCYTOMETRY/TC ADD-ON,88185,CPT,311,RC,,,,outpatient,,,42,4.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,456.96,430.08,1705.1,168,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,52.8,,399.84,399.84,2815.68,17,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,1759.8,1759.8,1759.8,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.72,18.35,330.3,23,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,53.55,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",53.55,448,,facility
UNLISTED MOLECULAR PATHOLOGY,81479,CPT,310,RC,,,,outpatient,,,2625,262.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,561.56,561.56,561.56,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,32.5,32.5,3071.5,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
X-RAY OF RIBS ON SIDE OF BODY; 2 VIEWS,71100,CPT,0320,RC,,,,outpatient,,,1207,120.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,85.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,174.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,21.02,21.02,21.02,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,84.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,83.29,448,,facility
PLATELETS; PHERESIS; PATHOGEN-REDUCED; EACH UNIT,P9073,HCPCS,0390,RC,,,,outpatient,,,1034,103.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,541.71,541.71,541.71,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,604.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,604.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,622.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,604.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1263.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,640.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,604.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,640.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,107,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,616.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,107,1263.3,,facility
X-RAY FROM NOSE TO RECTUM,76010,CPT,0320,RC,,,,outpatient,,,780,78,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,574.08,574.08,574.08,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,85.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,512.19,445.38,512.19,1 through 10,percent of total billed charges,,,33.6,,301.39,301.39,301.39,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,301.39,301.39,301.39,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,174.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,448.5,448.5,448.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.71,16.71,17.47,38,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,84.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,83.29,448,,facility
PARVOVIRUS ANTIBODY,86747,CPT,302,RC,,,,outpatient,,,39,3.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,31.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.48,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,15.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,15.03,448,,facility
FLUORESCENT ANTIBODY TITER,86256,CPT,302,RC,,,,outpatient,,,214,21.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.72,10.72,10.72,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.04,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.05,448,,facility
T CELL ABSOLUTE COUNT/RATIO,86360,CPT,302,RC,,,,outpatient,,,899,89.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,41.79,41.79,41.79,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,64.31,64.31,64.31,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,46.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,46.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,48.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,31.15,31.15,31.15,1 through 10,percent of total billed charges,,,33.6,,41.79,41.79,41.79,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,288.04,288.04,288.04,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,46.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,98.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,49.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,41.79,41.79,41.79,27,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,46.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,49.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,101.52,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,47.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,46.98,448,,facility
IMPLANTABLE TISSUE MARKER,A4648,HCPCS,278,RC,,,,outpatient,,,482,48.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,66,,204.28,102.14,5607.36,29,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,61,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,102.14,102.14,7905.6,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,52.8,,338.96,283.25,12161.94,1 through 10,percent of total billed charges,,,33.6,,377.46,377.46,377.46,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,2854.66,315.43,3661.2,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,474.19,226.38,2483.82,21,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,facility
EGFR GENE COM VARIANTS,81235,CPT,310,RC,,,,outpatient,,,1940,194,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,324.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,324.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,334.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,324.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,678.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,344.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,324.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,344.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,568.02,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,331.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,324.58,678.37,,facility
RIA NONANTIBODY,83519,CPT,301,RC,,,,outpatient,,,675,67.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,55.44,55.44,55.44,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.37,16.37,16.37,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.2,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.4,448,,facility
EMERGENCY DEPARTMENT VISIT FOR PROBLEM OF HIGH SEVERITY,99284,CPT,0450,RC,,,,outpatient,,,3460,346,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,373.62,349.77,375.75,1282,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,1614,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,3451,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,1817.08,1817.08,1817.08,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1200,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1500,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,399.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,399.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,411.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,2074.44,1220.69,2074.45,29,percent of total billed charges,,,33.6,,1220.69,1162.56,3528.92,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,1220.69,1162.56,1220.69,16,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,399.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,834.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,423.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,1816.5,1730,1816.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,741.37,741.37,741.37,1 through 10,percent of total billed charges,,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,246.57,245.82,379.2,956,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,399.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,423.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2893,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,407.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,399.34,3451,,facility
X-RAY OF INFANT BODY BONES,77076,CPT,0320,RC,,,,outpatient,,,685,68.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,438.4,438.4,438.4,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,94.7,94.14,94.7,13,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,448,,facility
VIRUS ANTIBODY NOS,86790,CPT,302,RC,,,,outpatient,,,69,6.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.46,11.46,11.46,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,107.86,20.06,169.49,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,116.52,40.29,122.3,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,26.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.46,11.46,11.46,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.88,448,,facility
MOPATH PROCEDURE LEVEL 6,81405,CPT,310,RC,,,,outpatient,,,1740,174,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,301.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,301.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,310.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,301.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,629.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,319.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,301.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,319.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,527.36,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,307.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,301.35,629.82,,facility
NOS EACH ORGANISM AG IA,87449,CPT,306,RC,,,,outpatient,,,248,24.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,198,198,198,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,26.27,26.27,26.27,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.66,10.66,10.66,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.9,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.98,448,,facility
MASS SPECTROMETRY QUAL/QUAN,83789,CPT,301,RC,,,,outpatient,,,148,14.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,24.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,50.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,25.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,24.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,25.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.19,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,24.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,24.11,448,,facility
DNA ANTIBODY NATIVE,86225,CPT,302,RC,,,,outpatient,,,224,22.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.22,12.22,12.22,16,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,32.21,29.57,46.46,11,percent of total billed charges,,,33.6,,29.57,29.57,29.57,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,29.66,29.57,98.11,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,28.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.22,12.22,12.22,49,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.7,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.74,448,,facility
PURAPLY XT 1 SQ CM,Q4197,HCPCS,636,RC,,,,outpatient,,,597,59.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,126.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,126.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,130.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,126.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,264.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,134.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,126.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,134.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,129.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,126.52,448,,facility
CORTISOL (HORMONE) MEASUREMENT; FREE,82530,CPT,0301,RC,,,,outpatient,,,89,8.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,211.2,211.2,211.2,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,34.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,14.86,14.86,14.86,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.1,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,16.71,448,,facility
ESTABLISHED PATIENT PERIODIC PREVENTIVE MEDICINE EXAMINATION (1-4 YEARS),99392,CPT,0770,RC,,,,outpatient,,,462,46.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,63.32,63.32,63.32,46,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
NUCLEAR ANTIGEN ANTIBODY,86235,CPT,302,RC,,,,outpatient,,,160,16,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13,12.5,15.95,11,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,54.91,4.37,90.29,43,percent of total billed charges,,,33.6,,4.37,4.37,53.09,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,22.18,4.24,83.33,13,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,37.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.95,13,15.95,54,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.75,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.93,448,,facility
TEST FOR DETECTING GENES ASSOCIATED WITH FETAL DISEASE; ANEUPLOIDY GENOMIC SEQUENCE ANALYSIS PANEL,81420,CPT,0310,RC,,,,outpatient,,,2013,201.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,675.16,675.16,675.16,181,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,1288.32,668.25,1288.32,15,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,1187.67,1187.67,1477.36,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,759.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,759.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,781.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,1062.86,676.37,1062.86,1 through 10,percent of total billed charges,,,33.6,,675.16,675.16,676.37,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,676.37,484.18,682.41,19,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,759.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1586.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,804.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,1006.5,1006.5,1006.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,593.47,593.47,593.47,1 through 10,percent of total billed charges,,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,675.16,675.16,675.16,133,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,759.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,804.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1328.34,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,774.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1586.41,,facility
INTERMEDIATE REPAIR OF WOUND OF SCALP; UNDERARMS; TRUNK; ARMS; OR LEGS; 7.6-12.5 CM,12034,CPT,0450,RC,,,,outpatient,,,1108,110.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,400.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,813.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,412.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,355.79,355.79,366.07,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,412.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,396.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,389.05,1311,,facility
MEASUREMENT OF VOLTAGE-GATED CALCIUM CHANNEL ANTIBODY,86596,CPT,0302,RC,,,,outpatient,,,998,99.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,36.48,36.48,36.48,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.72,10.72,10.72,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.2,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.05,448,,facility
DETECTION TEST BY IMMUNOASSAY WITH DIRECT VISUAL OBSERVATION FOR OTHER ORGANISM,87899,CPT,0306,RC,,,,outpatient,,,70,7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,33.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,14.29,14.29,14.29,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.12,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,16.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,16.07,448,,facility
NEG PRS WND THER NDME>50SQCM,97608,CPT,420,RC,,,,outpatient,,,1370,137,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,80,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,390.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,390.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,402.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,390.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,817.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,414.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,390.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,414.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,422,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,398.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,80,817.13,,facility
ELECTRON MICROSCOPY FOR DIAGNOSIS,88348,CPT,0310,RC,,,,outpatient,,,1200,120,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,716.75,711.24,771.08,14,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,2202.88,1496.32,2202.88,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,771.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,771.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,794.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,771.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1611.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,817.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,337.34,337.34,341.35,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,771.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,817.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,946.68,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,786.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1611.56,,facility
DETECTION TEST BY NUCLEIC ACID FOR DIGESTIVE TRACT PATHOGEN; MULTIPLE TYPES OR SUBTYPES; 12-25 TARGETS,87507,CPT,0306,RC,,,,outpatient,,,2300,230,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,416.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,416.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,429.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,416.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,871.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,441.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,1150,1150,1150,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,416.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,441.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,900.46,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,425.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,416.78,900.46,,facility
QUANTITATIVE ASSAY DRUG,80299,CPT,301,RC,,,,outpatient,,,190,19,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,13,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,174.64,174.64,174.64,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,171.6,171.6,171.6,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,374.52,374.52,374.52,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.62,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.64,448,,facility
VIRUS ANTIBODY NOS,86790,CPT,302,RC,,,,outpatient,,,60,6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.46,11.46,11.46,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,107.86,20.06,169.49,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,116.52,40.29,122.3,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,26.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.46,11.46,11.46,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.88,448,,facility
PROTHROMBIN TIME,85610,CPT,305,RC,,,,outpatient,,,282,28.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.82,3.82,3.82,148,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,25.6,25.6,68.48,85,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,63.13,63.13,63.13,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,35.95,16.37,61.1,101,percent of total billed charges,,,33.6,,21.12,13.44,56.5,20,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,13.56,13.44,36.27,76,percent of total billed charges,,,34.6,,38.84,38.84,40.77,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,8.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,53.5,20,141,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,22.47,8.4,22.47,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.82,3.82,3.82,801,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.49,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,4.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,4.29,448,,facility
RIA NONANTIBODY,83519,CPT,301,RC,,,,outpatient,,,550,55,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,55.44,55.44,55.44,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.37,16.37,16.37,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.2,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.4,448,,facility
UNLISTED MOLECULAR PATHOLOGY,81479,CPT,310,RC,,,,outpatient,,,2910,291,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,561.56,561.56,561.56,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,32.5,32.5,3071.5,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
LARYNGOSCOPE W/VC INJ,31570,CPT,761,RC,,,,outpatient,,,15001,1500.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3568.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3568.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3675.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3568.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,7457.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3782.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3568.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3782.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,3639.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,7457.62,,facility
DIALYSIS PROCEDURE INCLUDING 1 EVALUATION,90945,CPT,0851,RC,,,,outpatient,,,887,88.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,399.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,399.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,411.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,399.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,834.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,423.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,399.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,423.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2057,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,407.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,399.34,2057,,facility
COL CHROMOTOGRAPHY QUAL/QUAN,82542,CPT,301,RC,,,,outpatient,,,824,82.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,21.43,21.43,21.43,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,435.07,435.07,435.07,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,24.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,50.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,25.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,21.43,21.43,21.43,15,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,24.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,25.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.16,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,24.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,24.09,448,,facility
TEST TO MEASURE EXPIRATORY AIRFLOW AND VOLUME,94010,CPT,0460,RC,,,,outpatient,,,598,59.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,137.28,137.28,206.65,40,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,398.72,382.72,398.72,13,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,206.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,206.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,212.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,209.33,209.33,328.94,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,202.72,202.72,209.33,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,206.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,431.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,219.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.63,15.63,16.08,346,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,206.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,219.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,611,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,210.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,206.65,611,,facility
EXOME SEQUENCE ANALYSIS,81415,CPT,310,RC,,,,outpatient,,,1416,141.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4780,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4780,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4923.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4780,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,9990.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5066.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4780,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5066.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8365,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,4875.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,9990.2,,facility
VIRUS ANTIBODY NOS,86790,CPT,302,RC,,,,outpatient,,,195,19.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.46,11.46,11.46,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,107.86,20.06,169.49,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,116.52,40.29,122.3,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,26.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.46,11.46,11.46,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.88,448,,facility
COLLJ CAPILLARY BLOOD SPEC,36416,CPT,300,RC,,,,outpatient,,,16,1.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,63.36,63.36,63.36,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,40.32,40.32,40.32,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,50,,8,8,60,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,20.96,20.96,20.96,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.04,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",5.04,448,,facility
ASSAY OF IGE,82785,CPT,301,RC,,,,outpatient,,,308,30.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,14.64,14.64,14.64,32,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,44.88,28.56,175.87,1 through 10,percent of total billed charges,,,33.6,,124.52,124.52,124.52,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,28.56,28.56,28.56,1 through 10,percent of total billed charges,,,34.6,,32.29,32.29,117.35,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,34.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,14.64,14.64,14.64,106,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.56,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,16.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,16.46,448,,facility
TOXOPLASMA ANTIBODY IGM,86778,CPT,302,RC,,,,outpatient,,,235,23.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.82,12.82,12.82,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,30.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.82,12.82,12.82,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,31.12,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.41,448,,facility
ASSAY OF URINE OSMOLALITY,83935,CPT,301,RC,,,,outpatient,,,34,3.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,6.07,6.07,6.07,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,62.3,62.3,62.3,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,39.65,39.65,39.65,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,14.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,7.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,17,17,17,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,6.07,6.07,6.07,11,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,7.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.74,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,6.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,6.82,448,,facility
T CELLS TOTAL COUNT,86359,CPT,302,RC,,,,outpatient,,,303,30.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,33.56,33.56,33.56,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,37.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,37.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,82.68,82.68,82.68,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,78.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,39.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,33.56,33.56,33.56,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,39.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,81.52,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,38.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,37.73,448,,facility
SURGICAL PATHOLOGY CONSULTATION AND REPORT ON REFERRED MATERIAL REQUIRING PREPARATION OF SLIDES,88323,CPT,0312,RC,,,,outpatient,,,330,33,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,46.88,46,49.87,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,48.87,48.87,211.2,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,49.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,49.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,51.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,49.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,104.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,52.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,24.26,24.26,24.26,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,49.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,52.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,78.23,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,50.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,49.87,448,,facility
BLOOD CREATININE LEVEL,82565,CPT,0301,RC,,,,outpatient,,,58,5.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.55,4.55,4.55,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,34.22,10.24,34.22,11,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,30.62,19.49,61.25,61,percent of total billed charges,,,33.6,,19.49,19.49,38.98,20,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,19.49,19.49,38.98,55,percent of total billed charges,,,34.6,,30.62,30.62,30.62,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,10.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,29,29,29,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,12.18,12.18,12.18,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.55,4.55,4.55,281,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.08,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.12,448,,facility
HEMOGLOBIN CHROMOTOGRAPHY,83021,CPT,301,RC,,,,outpatient,,,636,63.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.06,16.06,16.06,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,37.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,58.38,58.38,58.38,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.06,16.06,16.06,16,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,39.01,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.06,448,,facility
BILIRUBIN LEVEL; DIRECT,82248,CPT,0300,RC,,,,outpatient,,,272,27.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,10.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.02,448,,facility
GENE ANALYSIS (T CELL ANTIGEN RECEPTOR BETA) AMPLIFICATION METHODOLOGY,81340,CPT,0310,RC,,,,outpatient,,,1122,112.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,185.83,185.83,185.83,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,208.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,208.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,215.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,208.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,436.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,221.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,208.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,221.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,451.36,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,213.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,208.92,451.36,,facility
CLOSED TREATMENT OF BROKEN HAND BONE WITH MANIPULATION,26605,CPT,0450,RC,,,,outpatient,,,3201,320.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,243.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,493.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,213.62,213.62,213.62,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,240.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,236.08,1311,,facility
MAGNESIUM LEVEL,83735,CPT,0300,RC,,,,outpatient,,,374,37.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,7.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,7.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.47,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,6.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,6.7,448,,facility
"INJECTION, RAMUCIRUMAB",J9308,HCPCS,636,RC,,,,outpatient,,,249,24.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,76.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,76.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,78.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,76.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,160.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,81.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,76.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,81.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,156.76,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,78.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,76.57,448,,facility
COMPLETE SINGLE SESSION COURSE OF CRANIAL LESION SURGERY USING RADIATION,77371,CPT,0333,RC,,,,outpatient,,,77648,7764.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,6279.27,6279.27,6707.31,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7049.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7049.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7260.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,7049.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,14732.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,7471.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,7049.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,7471.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,48815,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,7189.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,48815,,facility
ASSAY OF CRYOGLOBULIN,82595,CPT,301,RC,,,,outpatient,,,80,8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.75,5.75,5.75,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,38.54,38.54,38.54,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,13.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.75,5.75,5.75,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.97,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,6.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,6.47,448,,facility
RHEUMATOID FACTOR QUANT,86431,CPT,302,RC,,,,outpatient,,,225,22.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.04,5.04,5.04,26,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,33.63,33.63,33.63,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,30.1,19.05,30.1,1 through 10,percent of total billed charges,,,33.6,,19.15,19.15,30.1,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,19.15,19.15,19.24,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,11.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.04,5.04,5.04,75,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.25,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.67,448,,facility
CHIMERISM ANALYSIS POST TRANSPLANTATION; WITHOUT CELL SELECTION,81267,CPT,0310,RC,,,,outpatient,,,1745,174.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,184.53,184.53,184.53,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,207.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,207.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,213.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,1059.7,1059.7,1059.7,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,207.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,433.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,219.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,184.53,184.53,391.84,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,207.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,219.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,448.21,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,211.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,207.46,448.21,,facility
X-RAY OF FINGER; MINIMUM OF 2 VIEWS,73140,CPT,0320,RC,,,,outpatient,,,667,66.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,85.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,174.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,25.61,25.61,26.36,20,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,84.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,83.29,448,,facility
B CELLS TOTAL COUNT,86355,CPT,302,RC,,,,outpatient,,,311,31.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,33.56,33.56,33.56,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,60.77,60.77,60.77,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,37.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,37.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,27.98,27.98,27.98,1 through 10,percent of total billed charges,,,33.6,,33.56,33.56,33.56,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,63.63,63.63,63.63,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,78.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,39.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,33.56,33.56,33.56,25,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,39.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,81.52,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,38.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,37.73,448,,facility
DIAGNOSTIC EXAM OF LARGE BOWEL USING AN ENDOSCOPE INSERTED THROUGH SURGICALLY CREATED OPENING FROM LARGE BOWEL TO SKIN,44388,CPT,0750,RC,,,,outpatient,,,3740,374,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,799.94,399.97,811.89,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,890.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,890.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,916.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,890.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1860.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,943.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,405.95,405.95,811.89,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,890.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,943.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3821,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,907.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3821,,facility
NUCLEAR ANTIGEN ANTIBODY,86235,CPT,302,RC,,,,outpatient,,,356,35.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13,12.5,15.95,11,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,54.91,4.37,90.29,43,percent of total billed charges,,,33.6,,4.37,4.37,53.09,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,22.18,4.24,83.33,13,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,37.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.95,13,15.95,54,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.75,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.93,448,,facility
PSA (PROSTATE SPECIFIC ANTIGEN) MEASUREMENT; TOTAL,84153,CPT,0301,RC,,,,outpatient,,,298,29.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.36,16.36,16.36,28,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,49.86,25.75,175.82,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,100.13,28.56,157.34,43,percent of total billed charges,,,33.6,,100.13,28.56,101.02,12,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,28.56,28.56,101.02,71,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,42.5,42.5,42.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,17.85,17.85,17.85,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.36,16.36,16.36,55,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,39.74,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.39,448,,facility
COMPREHEN METABOLIC PANEL,80053,CPT,301,RC,,,,outpatient,,,52,5.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9.39,9.39,9.39,1527,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,30.68,30.68,604.75,68,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,33.28,33.28,33.28,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,27.46,17.47,585.27,705,percent of total billed charges,,,33.6,,344.4,17.47,541.2,199,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,17.63,17.47,347.48,855,percent of total billed charges,,,34.6,,372.07,42.7,390.52,33,percent of total billed charges,,,45,,9.39,9.39,9.39,1 through 10,percent of total billed charges,,10.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,22.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,26,26,512.5,60,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,215.25,10.92,215.25,37,percent of total billed charges,,,35,,512.5,512.5,512.5,1 through 10,percent of total billed charges,,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9.39,9.39,9.39,5909,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.82,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,10.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,10.56,448,,facility
SOMATOMEDIN (GROWTH FACTOR) LEVEL,84305,CPT,0301,RC,,,,outpatient,,,79,7.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,18.91,18.91,18.91,22,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,46.61,46.61,46.61,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,41.71,26.54,154.74,1 through 10,percent of total billed charges,,,33.6,,91.06,26.54,143.09,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,91.06,26.54,91.06,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,21.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,44.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,39.5,39.5,39.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,18.91,18.91,18.91,57,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,21.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,45.94,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,21.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,21.26,448,,facility
"INJ, BENDAMUSTINE HCL, 1MG",J9033,HCPCS,636,RC,,,,outpatient,,,147,14.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,2.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,6.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.87,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,3.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,2.96,448,,facility
HEPATITIS C AB TEST,86803,CPT,302,RC,,,,outpatient,,,790,79,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.69,12.69,12.69,218,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,91.45,91.45,91.45,15,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,81.84,52.08,81.84,78,percent of total billed charges,,,33.6,,52.08,52.08,81.84,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,52.08,52.08,52.46,140,percent of total billed charges,,,34.6,,48.01,16.95,50.09,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,29.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,77.5,77.38,77.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,12.69,12.69,12.69,1 through 10,percent of total billed charges,,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.69,12.69,12.69,465,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.82,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.27,448,,facility
ASSAY OF CHROMIUM,82495,CPT,301,RC,,,,outpatient,,,60,6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,20.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,42.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,21.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,20.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,21.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,43.82,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,20.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,20.28,448,,facility
APPLICATION OF NONMOVEABLE FOREARM TO HAND SPLINT,29125,CPT,0450,RC,,,,outpatient,,,224,22.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,131.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,266.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,134.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,134.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,129.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,127.33,448,,facility
CAST SUP SHRT LEG FIBERGLASS,Q4038,HCPCS,270,RC,,,,outpatient,,,134,13.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,52.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,52.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,54.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,52.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,109.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,55.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,52.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,55.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,53.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,52.48,448,,facility
TISSUE CULTURE INOCULATION FOR VIRUS ISOLATION,87252,CPT,0306,RC,,,,outpatient,,,157,15.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,26.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,54.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,27.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,26.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,27.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,56.32,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,26.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,26.07,448,,facility
URINE PREGNANCY TEST,81025,CPT,0300,RC,,,,outpatient,,,82,8.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,17.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,9.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,9.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.07,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,8.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,8.61,448,,facility
BLOOD GROUP TYPING (ABO),86900,CPT,0302,RC,,,,outpatient,,,352,35.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,113.1,113.1,127.33,523,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,207.68,21.24,207.68,13,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,131.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,118.27,18.88,200.99,116,percent of total billed charges,,,33.6,,118.27,18.88,118.27,44,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,118.27,12.1,134.11,78,percent of total billed charges,,,34.6,,130.24,127.78,134.11,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,266.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,134.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,176,17.88,176,13,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,73.92,7.56,73.92,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,2.66,2.66,2.66,1 through 10,percent of total billed charges,,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,2.66,2.66,2.66,824,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,134.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.46,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,129.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,6.46,448,,facility
PLATELETS; PHERESIS; LEUKOCYTES REDUCED; IRRADIATED; EACH UNIT,P9037,HCPCS,0390,RC,,,,outpatient,,,6845,684.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,623.23,623.23,1246.46,12,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,4380.8,4380.8,8761.6,13,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,677.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,677.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,697.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,7816.99,7816.99,7816.99,1 through 10,percent of total billed charges,,,33.6,,2299.92,2299.92,4599.84,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,4969.47,2607.94,5215.89,11,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,677.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1415.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,717.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,483.98,483.98,967.96,48,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,677.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,717.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,107,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,690.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,107,1415.52,,facility
DIAGNOSTIC EXAM OF LARGE BOWEL USING A FLEXIBLE ENDOSCOPE,45378,CPT,0750,RC,,,,outpatient,,,3744,374.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,799.94,399.97,837.43,14,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,890.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,890.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,916.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,2185.27,1269.22,2185.29,1 through 10,percent of total billed charges,,,33.6,,1635.31,1635.31,1635.31,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,1635.31,1269.22,1635.31,15,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,890.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1860.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,943.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,811.89,0.12,837.43,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,890.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,943.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3821,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,907.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3821,,facility
SPECTROPHOTOMETRY,84311,CPT,301,RC,,,,outpatient,,,28,2.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,7.2,7.2,7.2,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,45.35,45.35,53.33,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,16.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,7.2,7.2,7.2,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.1,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,8.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,8.1,448,,facility
X-RAY OF SACRUM AND TAILBONE; MINIMUM OF 2 VIEWS,72220,CPT,0320,RC,,,,outpatient,,,829,82.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,530.56,530.56,530.56,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,85.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,278.54,278.54,278.54,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,174.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.68,19.68,20.25,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,84.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,83.29,448,,facility
BLOOD UNIT COMPATIBILITY TEST; ELECTRONIC,86923,CPT,0302,RC,,,,outpatient,,,349,34.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,150.35,150.35,269.89,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,205.91,205.91,617.73,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,167.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,184.27,184.27,398.56,1 through 10,percent of total billed charges,,,33.6,,117.26,117.26,199.28,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,236.62,236.62,236.62,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,340.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,172.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,172.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,226.07,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,166.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,163.06,448,,facility
THROMBIN TIME PLASMA,85670,CPT,305,RC,,,,outpatient,,,280,28,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,12.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.46,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.77,448,,facility
RBC LEUKOCYTES REDUCED,P9016,HCPCS,390,RC,,,,outpatient,,,2348,234.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,169.72,167.88,335.75,32,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,1502.72,1502.72,1502.72,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,184,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,184,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,189.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,1340.71,1239.74,2479.49,1 through 10,percent of total billed charges,,,33.6,,1239.74,788.93,1340.71,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,795.97,795.97,795.97,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,184,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,384.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,195.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,4930.8,4930.8,4930.8,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,136.54,136.54,273.08,30,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,184,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,195.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,107,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,187.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,107,448,,facility
HYDROXYPROGESTERONE; 17-D (SYNTHETIC HORMONE) LEVEL,83498,CPT,0301,RC,,,,outpatient,,,70.4,7.04,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,24.17,24.17,24.17,28,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,27.14,27.14,27.14,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,37.17,36.96,302.02,1 through 10,percent of total billed charges,,,33.6,,23.52,23.52,23.52,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,23.52,15.46,96.1,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,27.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,56.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,28.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,24.17,24.17,24.17,45,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,27.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,28.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,58.7,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,27.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,27.17,448,,facility
ULTRASONIC GUIDANCE FOR NEEDLE PLACEMENT,76942,CPT,0402,RC,,,,outpatient,,,2081,208.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,31.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,934.37,934.37,934.37,1 through 10,percent of total billed charges,,,33.6,,699.22,699.22,699.22,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,30.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,63.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,32.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,30.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,32.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,465,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,30.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,30.24,465,,facility
NUSHIELD 1 SQUARE CM,Q4160,HCPCS,636,RC,,,,outpatient,,,218,21.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,126.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,126.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,130.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,126.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,264.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,134.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,126.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,134.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,129.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,126.52,448,,facility
BIOPSY OF FLOOR OF MOUTH,41108,CPT,0761,RC,,,,outpatient,,,3201,320.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1628.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3303.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1675.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1675.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,1612.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3303.62,,facility
DIAGNOSTIC EXAM OF ESOPHAGUS USING A FLEXIBLE ENDOSCOPE THROUGH MOUTH,43200,CPT,0750,RC,,,,outpatient,,,4087,408.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,822.62,822.62,822.62,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,868.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,868.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,894.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,868.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1814.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,920.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,868.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,920.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3821,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,885.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3821,,facility
TB AG RESPONSE T-CELL SUSP,86481,CPT,302,RC,,,,outpatient,,,109,10.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,175,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100,448,,facility
CYTOGENETICS DNA PROBE,88271,CPT,311,RC,,,,outpatient,,,539,53.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.05,19.05,19.05,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,1274.11,1274.11,1274.11,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,477.79,477.79,477.79,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,21.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,44.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.05,19.05,19.05,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,21.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,46.27,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,21.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,21.42,448,,facility
UNLISTED MOLECULAR PATHOLOGY,81479,CPT,310,RC,,,,outpatient,,,2850,285,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,561.56,561.56,561.56,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,32.5,32.5,3071.5,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
TREATMENT OF BEHAVIOR IMPACTING HEALTH; INITIAL 30 MINUTES,96158,CPT,0914,RC,,,,outpatient,,,244,24.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,156.69,140.97,169.87,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,169.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,169.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,174.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,169.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,355.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,180.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,169.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,180.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,173.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,169.87,448,,professional
CONTINUOUS MONITORING OF BLOOD SUGAR LEVEL IN TISSUE FLUID USING SENSOR UNDER SKIN WITH PROVIDER SUPPLIED EQUIPMENT,95250,CPT,0920,RC,,,,outpatient,,,438,43.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,127.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,127.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,131.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,127.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,266.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,135.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,127.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,135.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,422,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,129.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,127.42,448,,facility
SYPHILIS TEST NON-TREP QUAL,86592,CPT,302,RC,,,,outpatient,,,361,36.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.8,3.8,3.8,262,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,28.8,3.16,28.8,20,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,26.55,26.4,79.65,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,28.8,28.8,28.8,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,23.76,15.12,23.76,39,percent of total billed charges,,,33.6,,15.17,15.12,45.36,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,15.12,15.12,15.17,34,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,8.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,22.38,22.38,22.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.8,3.8,3.8,282,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.22,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,4.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,4.27,448,,facility
AMINOLEVULINIC ACID (PROTEIN) LEVEL,82135,CPT,0301,RC,,,,outpatient,,,112,11.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,14.63,14.63,14.63,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,34.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.54,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,16.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,16.45,448,,facility
APPLICATION AND REMOVAL OF DENTAL FIXATION DEVICE,21110,CPT,0450,RC,,,,outpatient,,,4202,420.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1484.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1484.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1529.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1484.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3103.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1574.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1484.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1574.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1514.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3103.57,,facility
VIRUS ANTIBODY NOS,86790,CPT,302,RC,,,,outpatient,,,450,45,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.46,11.46,11.46,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,107.86,20.06,169.49,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,116.52,40.29,122.3,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,26.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.46,11.46,11.46,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.88,448,,facility
DIRECT ADMISSION OF PATIENT FOR HOSPITAL OBSERVATION CARE,G0379,HCPCS,0762,RC,,,,outpatient,,,1580,158,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,2323.13,2308.93,2518.57,28,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,94.17,,,,,,,case rate,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,230,,,,,,,case rate,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,3978.5,3978.5,3978.5,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,572.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,572.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,589.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,59,,,,,,,case rate,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,572.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1197.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,607.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,572.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,607.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,584.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,59,1197.07,,facility
ANALYSIS FOR ANTIBODY TO COCCIDIOIDES (BACTERIA),86635,CPT,0302,RC,,,,outpatient,,,203,20.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,107.18,107.18,107.18,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,23.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.2,10.2,10.2,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.8,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,11.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.47,448,,facility
URINE VANILLYLMANDELIC ACID,84585,CPT,0301,RC,,,,outpatient,,,49,4.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.79,13.79,13.79,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,32.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.79,13.79,13.79,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,33.48,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,15.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,15.5,448,,facility
DRESSING CHANGE UNDER ANESTHESIA,15852,CPT,0761,RC,,,,outpatient,,,1759,175.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,707.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,707.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,728.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,707.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1478.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,749.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,577.76,577.76,577.76,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,707.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,749.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,721.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1478.34,,facility
CALCIUM LEVEL; TOTAL,82310,CPT,0301,RC,,,,outpatient,,,340,34,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.59,4.59,4.59,15,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,28.32,28.32,28.32,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,16.13,16.13,50.25,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,16.13,16.13,114.24,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,10.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,71.4,71.4,71.4,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.59,4.59,4.59,27,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.15,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.16,448,,facility
COL CHROMOTOGRAPHY QUAL/QUAN,82542,CPT,301,RC,,,,outpatient,,,300,30,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,21.43,21.43,21.43,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,435.07,435.07,435.07,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,24.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,50.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,25.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,21.43,21.43,21.43,15,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,24.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,25.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.16,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,24.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,24.09,448,,facility
STOOL CALPROTECTIN (PROTEIN) LEVEL,83993,CPT,0301,RC,,,,outpatient,,,319,31.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,17.46,17.46,17.46,30,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,158.4,100.8,168.43,1 through 10,percent of total billed charges,,,33.6,,168.43,100.8,225.98,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,107.18,107.18,107.18,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,41.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,20.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,159.5,159.5,159.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,17.46,17.46,17.46,68,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,20.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.42,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,20.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,19.63,448,,facility
AMINO ACID LEVEL; 6 OR MORE AMINO ACIDS; QUANTITATIVE; EACH SPECIMEN,82139,CPT,0301,RC,,,,outpatient,,,679,67.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.01,12,15.01,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,230.18,110.21,262.42,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,35.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,164.01,164.01,164.01,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.01,12,15.01,16,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.45,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,16.87,448,,facility
4-BAR LINK ABOVE KNEE W/SWNG,L5614,HCPCS,274,RC,,,,outpatient,,,3072,307.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,66,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,61,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2088.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2088.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2151.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2088.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,4365.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2214.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2088.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2214.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,2130.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,2088.9,4365.8,,facility
CHROMOSOME ANALYSIS 20-25,88264,CPT,311,RC,,,,outpatient,,,2185,218.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,144.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,144.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,148.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,144.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,302.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,153.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,144.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,153.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,269.29,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,147.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,144.61,448,,facility
REMOVAL OF FOREIGN BODY FROM EXTERNAL EYE (CONJUNCTIVA OR SCLERA),65210,CPT,0450,RC,,,,outpatient,,,860,86,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,427.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,427.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,440.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,427.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,893.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,453.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,427.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,453.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,436.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,427.54,893.56,,facility
CYTOGENETICS DNA PROBE,88271,CPT,311,RC,,,,outpatient,,,505,50.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.05,19.05,19.05,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,1274.11,1274.11,1274.11,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,477.79,477.79,477.79,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,21.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,44.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.05,19.05,19.05,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,21.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,46.27,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,21.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,21.42,448,,facility
HEPATITIS B CORE ANTIBODY MEASUREMENT,86704,CPT,0302,RC,,,,outpatient,,,112,11.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.72,10.72,10.72,67,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,71.68,71.68,83.84,35,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,66.08,66.08,66.08,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,59.14,37.63,59.14,29,percent of total billed charges,,,33.6,,59.14,37.63,59.14,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,37.63,37.63,37.97,41,percent of total billed charges,,,34.6,,38.48,13.53,47.55,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,56,56,56,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.72,10.72,10.72,161,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.04,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.05,448,,facility
CULTURE TYPE IMMUNOLOGIC,87147,CPT,306,RC,,,,outpatient,,,133,13.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.61,4.61,4.61,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,69.03,69.03,69.03,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,57.55,36.95,66.81,12,percent of total billed charges,,,33.6,,39.31,39.31,39.31,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,39.31,39.31,39.31,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,10.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,58.5,58.5,58.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.61,4.61,4.61,65,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.18,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.18,448,,facility
PML/RARALPHA COM BREAKPOINTS,81315,CPT,310,RC,,,,outpatient,,,1375,137.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,184.4,184.4,184.4,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,207.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,207.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,213.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,207.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,433.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,219.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,184.4,184.4,184.4,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,207.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,219.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,447.9,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,211.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,207.31,448,,facility
RADIATION THERAPY DOSE PLAN,77300,CPT,333,RC,,,,outpatient,,,2250,225,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,4320,1440,5760,32,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,6637.5,6637.5,6637.5,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,128.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,128.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,132.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,1512,756,3564,13,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,1525.5,1512,4536,13,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,128.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,268.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,136.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,1125,1125,5625,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,27.77,27.77,27.77,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,128.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,136.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,48815,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,131.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,128.64,48815,,facility
WBC ANTIBODY IDENTIFICATION,86021,CPT,302,RC,,,,outpatient,,,259,25.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.39,13.39,13.39,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,20.59,13.1,38.54,1 through 10,percent of total billed charges,,,33.6,,134.11,134.11,134.11,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,13.1,13.1,13.1,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,31.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.39,13.39,13.39,23,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.53,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,15.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,15.05,448,,facility
SPECIAL STAIN FOR PARASITES,87209,CPT,0306,RC,,,,outpatient,,,15.25,1.53,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15,15,15.99,19,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,9.6,9.6,9.6,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,7.92,5.04,7.92,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,5.04,5.04,5.04,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,37.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15,15,15.99,18,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.98,448,,facility
BIOPSY OF ANUS USING AN ENDOSCOPE,46606,CPT,0750,RC,,,,outpatient,,,1584,158.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1179.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,2393.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1213.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1213.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3821,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1168.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3821,,facility
HFE GENE,81256,CPT,310,RC,,,,outpatient,,,888,88.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,58.14,58.14,58.14,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,65.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,65.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,67.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,65.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,136.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,69.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,65.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,69.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,141.21,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,66.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,65.36,448,,facility
SACITUZUMAB GOVITECAN-HZIY,J9317,HCPCS,636,RC,,,,outpatient,,,118,11.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,37.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,37.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,78.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,39.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,39.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,76.2,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,38.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,37.64,448,,facility
BLOOD SPLIT UNIT,P9011,HCPCS,390,RC,,,,outpatient,,,161,16.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,141.8,130.8,155.08,21,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,558.72,558.72,558.72,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,155.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,155.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,159.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,155.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,324.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,164.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,155.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,164.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,107,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,158.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,107,448,,facility
NORMAL SALINE SOLUTION INFUS,J7050,HCPCS,636,RC,,,,outpatient,,,14,1.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,5.12,5.12,10.24,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,2.66,1.33,4.59,52,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",448,448,,facility
COMPLETE ULTRASOUND SCAN OF PELVIS,76856,CPT,0402,RC,,,,outpatient,,,1759,175.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,93.3,92.3,93.3,33,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,1037.81,1037.81,1037.81,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,928.75,591.02,1004.39,1 through 10,percent of total billed charges,,,33.6,,591.02,591.02,591.02,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,591.02,591.02,591.02,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,879.5,879.5,879.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,58.51,58.51,61.07,49,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,465,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,465,,facility
CAST SUP LNG ARM SPLINT FBRG,Q4018,HCPCS,270,RC,,,,outpatient,,,56,5.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,18.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.48,448,,facility
ASSAY OF MAGNESIUM,83735,CPT,301,RC,,,,outpatient,,,43,4.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.96,5.96,5.96,292,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,9.38,5.96,25.37,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,197.47,22.7,213.55,144,percent of total billed charges,,,33.6,,125.66,125.66,126.79,59,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,125.66,14.45,142.49,154,percent of total billed charges,,,34.6,,135.76,135.76,142.49,1 through 10,percent of total billed charges,,,45,,5.96,5.96,5.96,1 through 10,percent of total billed charges,,6.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,7.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,21.5,21.5,187,13,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,78.54,78.54,78.54,21,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.96,5.96,5.96,1555,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,7.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.47,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,6.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,6.7,448,,facility
INSERTION OF TUBE INTO INTRACRANIAL ARTERY FOR DIAGNOSIS OR TREATMENT WITH REVIEW BY RADIOLOGIST,36223,CPT,0323,RC,,,,outpatient,,,15810,1581,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5325.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5325.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5485.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5325.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,11130.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5645.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4813.86,4813.86,4813.86,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5325.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5645.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5432.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,443,11130.36,,facility
ASSAY OF PROTEIN SERUM,84155,CPT,301,RC,,,,outpatient,,,40,4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.26,3.26,3.26,55,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,23.6,23.6,23.6,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,316,316,316,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,180.44,21.12,180.44,76,percent of total billed charges,,,33.6,,106.18,13.44,180.44,18,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,106.18,13.44,107.12,57,percent of total billed charges,,,34.6,,120.4,120.4,120.4,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,7.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,158,20,158,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,8.4,8.4,8.4,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.26,3.26,3.26,650,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.93,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,3.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,3.67,448,,facility
MOPATH PROCEDURE LEVEL 9,81408,CPT,310,RC,,,,outpatient,,,1544,154.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2000,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2000,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2060,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2000,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,4180,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2120,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2000,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2120,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3500,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,2040,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,4180,,facility
ULTRASOUND SCAN OF UTERUS; OVARIES; TUBES; CERVIX AND PELVIC AREA THROUGH VAGINA,76830,CPT,0402,RC,,,,outpatient,,,1853,185.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,93.3,92.3,100.06,46,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,1185.92,1185.92,1185.92,23,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,1093.27,1093.27,1093.27,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,978.38,622.61,1058.06,11,percent of total billed charges,,,33.6,,628.17,622.61,978.38,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,622.61,622.61,628.17,21,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,926.5,926.5,926.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,68.76,68.76,72.43,35,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,465,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,465,,facility
HO ABDUCTION STATIC PLASTIC,L1660,HCPCS,274,RC,,,,outpatient,,,390,39,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,66,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,61,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,262.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,262.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,270.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,262.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,548.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,277.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,262.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,277.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,267.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,262.21,548.02,,facility
FLOWCYTOMETRY/ TC 1 MARKER,88184,CPT,311,RC,,,,outpatient,,,224,22.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,315.62,315.62,343.05,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,546.56,546.56,731.52,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,343.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,343.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,353.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,286.94,286.94,384.05,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,343.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,716.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,363.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,179.34,179.34,179.34,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,63.07,63.07,165.15,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,343.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,363.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,377,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,349.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,343.05,716.97,,facility
WESTERN BLOT TEST,84181,CPT,301,RC,,,,outpatient,,,477,47.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,35.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.79,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.03,448,,facility
DETECT AGENT NOS DNA AMP,87798,CPT,306,RC,,,,outpatient,,,917,91.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,110.88,110.88,174.24,1 through 10,percent of total billed charges,,,33.6,,244.27,244.27,244.27,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,96.77,32.38,119.79,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,38.9,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
CLOTTING FUNCT ACTIVITY,85397,CPT,305,RC,,,,outpatient,,,340,34,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,27.45,27.45,27.45,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,31.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,30.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,64.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,32.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,27.45,27.45,27.45,13,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,30.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,32.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,54.01,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,31.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,30.86,448,,facility
BIOPSY OF ESOPHAGUS; STOMACH; AND/OR UPPER SMALL BOWEL USING A FLEXIBLE ENDOSCOPE,43239,CPT,0750,RC,,,,outpatient,,,3983,398.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,800.68,400.34,822.62,144,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,458,458,916,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,868.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,868.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,894.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,1988.16,1487.81,1988.17,15,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,1487.81,1350.24,1487.81,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,868.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1814.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,920.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,2214,2214,2214,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,834.91,408.37,834.91,165,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,868.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,920.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3821,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,885.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3821,,facility
RHEUMATOID FACTOR QUANT,86431,CPT,302,RC,,,,outpatient,,,216,21.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.04,5.04,5.04,26,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,33.63,33.63,33.63,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,30.1,19.05,30.1,1 through 10,percent of total billed charges,,,33.6,,19.15,19.15,30.1,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,19.15,19.15,19.24,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,11.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.04,5.04,5.04,75,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.25,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.67,448,,facility
MENB-4C VACCINE IM,90620,CPT,636,RC,,,,outpatient,,,5,0.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
IMMUNODIFFUSION OUCHTERLONY,86331,CPT,302,RC,,,,outpatient,,,36,3.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.66,10.66,10.66,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.88,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.98,448,,facility
URINE MICROALBUMIN (PROTEIN) LEVEL,82043,CPT,0301,RC,,,,outpatient,,,88.25,8.83,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.14,5.14,5.14,85,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,38.35,29.5,51.92,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,46.46,26.4,46.46,31,percent of total billed charges,,,33.6,,29.57,16.95,46.6,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,29.57,21.84,29.92,43,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,12.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,163.5,32.5,188.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,13.65,13.65,18.53,1 through 10,percent of total billed charges,,,35,,17.34,17.34,17.34,1 through 10,percent of total billed charges,,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.14,5.14,5.14,290,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.5,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.78,448,,facility
THEOPHYLLINE LEVEL,80198,CPT,0301,RC,,,,outpatient,,,40,4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,29.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.56,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.14,448,,facility
LORAZEPAM INJECTION,J2060,HCPCS,636,RC,,,,outpatient,,,78,7.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,46.02,46.02,46.02,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,52.8,,2.2,1.19,6.89,1 through 10,percent of total billed charges,,,33.6,,3.44,3.44,3.44,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,2.68,2.2,3.44,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",448,448,,facility
PSA SCREENING,G0103,HCPCS,301,RC,,,,outpatient,,,284,28.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,40.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,20.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,20.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,39.74,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,19.31,448,,facility
OTHER PROCEDURE ON BLOOD VESSEL,37799,CPT,0761,RC,,,,outpatient,,,951,95.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,600.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,600.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,618.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,448.67,448.67,448.67,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,600.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1254.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,636.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,600.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,636.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,599.86,126.95,599.86,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,612.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1311,,facility
MRI JOINT UPR EXTREM W/O DYE,73221,CPT,610,RC,,,,outpatient,,,6024,602.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,786,,,,,,,case rate,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,728,,,,,,,case rate,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1025,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1350,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,235.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,477.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,242.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,242.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2407,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,232.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,228.36,2407,,facility
UNLISTED CHEMISTRY PROCEDURE,84999,CPT,301,RC,,,,outpatient,,,348,34.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
FLOWCYTOMETRY/ TC 1 MARKER,88184,CPT,311,RC,,,,outpatient,,,3665,366.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,315.62,315.62,343.05,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,546.56,546.56,731.52,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,343.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,343.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,353.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,286.94,286.94,384.05,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,343.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,716.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,363.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,179.34,179.34,179.34,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,63.07,63.07,165.15,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,343.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,363.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,377,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,349.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,343.05,716.97,,facility
DELIVERY OF SIMPLE HIGH PRECISION RADIATION TREATMENT,77385,CPT,0333,RC,,,,outpatient,,,3674,367.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,507.55,507.55,507.55,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,2351.36,2351.36,2351.36,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,2167.66,2167.66,2167.66,13,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 103.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment.",,,,0,other,"Payer contract is 103.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment. + No services performed during 15-month lookback period",,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,1234.46,1234.46,1245.49,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment. + No services performed during 15-month lookback period",,,"Payer contract is 209.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment.",,,,0,other,"Payer contract is 209.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment. + No services performed during 15-month lookback period",,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment. + No services performed during 15-month lookback period",,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,515.14,515.14,515.14,56,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment.",550.25,550.25,550.25,88,other,"Payer contract is 100.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment.",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,48815,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,"Payer contract is 102.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment.",561.26,561.26,561.26,423,other,"Payer contract is 102.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment.",448,48815,,facility
ASSAY OF OXALATE,83945,CPT,301,RC,,,,outpatient,,,273,27.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,30.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.85,12.85,12.85,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.81,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.45,448,,facility
UNLISTED MOLECULAR PATHOLOGY,81479,CPT,310,RC,,,,outpatient,,,508,50.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,561.56,561.56,561.56,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,32.5,32.5,3071.5,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
APPLICATION OF SHORT LEG SPLINT FROM CALF TO FOOT,29515,CPT,0450,RC,,,,outpatient,,,453,45.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,138.44,138.44,138.44,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,155.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,155.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,160.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,155.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,325.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,164.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,155.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,164.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,158.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,155.52,448,,facility
ASSAY OF TROPONIN QUANT,84484,CPT,301,RC,,,,outpatient,,,610,61,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.09,11.09,11.09,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,312,312,312,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,83.94,49.39,178.15,66,percent of total billed charges,,,33.6,,83.94,49.39,126.14,15,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,49.39,49.39,148.18,37,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,26.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,156,156,312,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,23.73,23.73,23.73,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.09,11.09,11.09,460,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.82,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.47,448,,facility
ISLET CELL ANTIBODY,86341,CPT,302,RC,,,,outpatient,,,825,82.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,20.97,20.97,20.97,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,23.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,23.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,143.62,143.62,326.83,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,258.38,258.38,258.38,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,23.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,49.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,24.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,20.97,20.97,20.97,14,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,23.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,24.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.75,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,24.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,23.57,448,,facility
PROINSULIN (PANCREATIC HORMONE) LEVEL,84206,CPT,0301,RC,,,,outpatient,,,290,29,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,26.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,55.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,28.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,26.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,28.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,46.71,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,27.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,26.69,448,,facility
TREAT ANKLE DISLOCATION,27840,CPT,761,RC,,,,outpatient,,,2910,291,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,243.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,493.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,240.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,236.08,1173,,facility
LACER MOLDED TO PATIENT MODE,L2330,HCPCS,274,RC,,,,outpatient,,,711,71.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,66,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,61,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,478.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,478.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,492.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,478.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,999.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,506.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,478.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,506.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,487.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,478.23,999.5,,facility
MITOCHONDRIAL ANTIBODY EACH,86381,CPT,302,RC,,,,outpatient,,,65,6.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,22.64,22.64,22.64,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,45.41,16.13,249.13,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,28.9,28.9,28.9,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,25.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,53.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,26.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,22.64,22.64,22.64,19,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,25.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,26.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,44.54,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,25.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,25.45,448,,facility
ANTINUCLEAR ANTIBODIES,86038,CPT,302,RC,,,,outpatient,,,215,21.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.75,10.75,10.75,34,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,148.09,148.09,148.09,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,84.34,29.04,132.53,14,percent of total billed charges,,,33.6,,84.34,18.48,127.78,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,84.34,84.34,85.09,12,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,11.55,11.55,11.55,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.75,10.75,10.75,126,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.11,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.09,448,,facility
EPSTEIN-BARR NUCLEAR ANTIGEN,86664,CPT,302,RC,,,,outpatient,,,171,17.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.6,13.6,13.6,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,49.92,22.4,49.92,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,41.18,41.18,41.18,1 through 10,percent of total billed charges,,,33.6,,71.57,71.57,71.57,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,28.56,28.56,71.57,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,31.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.6,13.6,13.6,15,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,33.04,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,15.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,15.29,448,,facility
ASSAY OF LEAD,83655,CPT,301,RC,,,,outpatient,,,128,12.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.77,10.77,10.77,70,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,47.79,47.79,47.79,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,27.22,27.22,42.77,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,11.76,11.76,27.22,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,40.5,40.5,40.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.77,10.77,10.77,84,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.16,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.11,448,,facility
CONIZATION OF CERVIX,57522,CPT,761,RC,,,,outpatient,,,7895,789.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3098.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3098.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3191.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3098.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,6475.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3284,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3098.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3284,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,3160.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,6475.05,,facility
HEROIN METABOLITE,80356,CPT,301,RC,,,,outpatient,,,105,10.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
MOPATH PROCEDURE LEVEL 5,81404,CPT,310,RC,,,,outpatient,,,235,23.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,274.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,274.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,283.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,274.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,574.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,291.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,274.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,291.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,480.95,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,280.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,274.83,574.39,,facility
INCISION OF EXTERNAL HEMORRHOID WITH BLOOD CLOT,46083,CPT,0456,RC,,,,outpatient,,,3201,320.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,239.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,239.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,246.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,239.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,499.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,253.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,239.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,253.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,405,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,243.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,239.12,1173,,facility
NUCLEAR ANTIGEN ANTIBODY,86235,CPT,302,RC,,,,outpatient,,,460,46,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13,12.5,15.95,11,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,54.91,4.37,90.29,43,percent of total billed charges,,,33.6,,4.37,4.37,53.09,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,22.18,4.24,83.33,13,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,37.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.95,13,15.95,54,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.75,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.93,448,,facility
DRUG SCREENING PROPOXYPHENE,80367,CPT,301,RC,,,,outpatient,,,339,33.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
HEROIN METABOLITE,80356,CPT,301,RC,,,,outpatient,,,182,18.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
ELEC KNEE-SHIN SWING ONLY,L5857,HCPCS,274,RC,,,,outpatient,,,15498,1549.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,66,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,61,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Stoploss First Dollar + Reimbursement Rate 50.00 + Percent Of Charge + Reimbursement Rate 0.00 + Fixed Amount 3149.00,,,,0,other,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,Stoploss First Dollar + Reimbursement Rate 50.00 + Percent Of Charge + Reimbursement Rate 0.00 + Fixed Amount 3149.00,,,,0,other,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,10544.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10544.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10861.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10544.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,22038.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11177.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10544.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11177.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,10755.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,10544.8,22038.63,,facility
NATRIURETIC PEPTIDE (HEART AND BLOOD VESSEL PROTEIN) LEVEL,83880,CPT,0301,RC,,,,outpatient,,,779,77.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,34.92,34.92,34.92,37,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,39.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,39.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,40.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,261.74,127.51,444.81,39,percent of total billed charges,,,33.6,,261.74,261.74,444.81,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,81.87,81.31,261.74,29,percent of total billed charges,,,34.6,,89.35,89.35,89.35,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,39.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,82.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,41.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,389.5,389.5,389.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,34.92,34.92,34.92,366,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,39.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,41.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,73.33,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,40.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,39.26,448,,facility
DGP ANTIBODY EACH IG CLASS,86258,CPT,302,RC,,,,outpatient,,,151,15.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.72,10.72,10.72,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,10.62,10.62,10.62,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,31.58,6.1,49.63,18,percent of total billed charges,,,33.6,,6.05,6.05,6.05,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,6.05,6.05,6.1,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,9,9,9,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.72,10.72,10.72,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.18,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.05,448,,facility
EVALUATION FOR PHYSICAL THERAPY; TYPICALLY 30 MINUTES,97162,CPT,0424,RC,,,,outpatient,,,636,63.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,51.96,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,89.84,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,80,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,92.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,92.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,95.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,92.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,194.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,98.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,92.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,98.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,422,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,94.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,51.96,448,,facility
ALPHA-FETOPROTEIN (AFP) LEVEL; AMNIOTIC FLUID,82106,CPT,0301,RC,,,,outpatient,,,213,21.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,35.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,212.79,212.79,212.79,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.24,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17,448,,facility
NEUROMUSCULAR JUNCTION TEST,95937,CPT,922,RC,,,,outpatient,,,749,74.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,123.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,123.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,126.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,123.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,257.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,130.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,123.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,130.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,478,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,125.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,123.14,478,,facility
INITIAL NEW PATIENT PREVENTIVE MEDICINE EVALUATION (5-11 YEARS),99383,CPT,0770,RC,,,,outpatient,,,594,59.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,72.03,72.03,72.03,21,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,0.22,0.22,0.22,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
ASSAY OF PROSTAGLANDIN,84150,CPT,301,RC,,,,outpatient,,,485,48.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,41.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,41.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,43.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,41.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,87.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,44.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,41.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,44.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,73.1,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,42.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,41.77,448,,facility
X-RAY OF LOWER AND SACRAL SPINE; 2-3 VIEWS,72100,CPT,0320,RC,,,,outpatient,,,681,68.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,528.64,435.84,528.64,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,487.34,487.34,487.34,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,359.57,277.54,471.65,18,percent of total billed charges,,,33.6,,436.13,436.13,436.13,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,277.54,277.54,277.54,11,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,23.45,23.45,24.41,22,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,448,,facility
DETECTION TEST BY IMMUNOFLUORESCENT TECHNIQUE FOR PNEUMOCYSTIS CARINII (RESPIRATORY PARASITE),87281,CPT,0306,RC,,,,outpatient,,,487,48.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.66,10.66,10.66,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.9,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.98,448,,facility
VIRUS INOCULATION SHELL VIA,87254,CPT,306,RC,,,,outpatient,,,154,15.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,40.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,20.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,20.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.26,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,19.56,448,,facility
FOLLOW-THROUGH X-RAY OF SMALL INTESTINES,74248,CPT,0320,RC,,,,outpatient,,,138,13.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,31.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,60.14,60.14,60.14,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,30.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,64.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,32.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,30.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,32.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,31.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,30.91,448,,facility
"INJ, HYDROMORPHONE, 0.1 MG",J1171,HCPCS,636,RC,,,,outpatient,,,0.4,0.04,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,27.2,27.2,27.2,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,52.8,,3.71,1.27,14.28,383,percent of total billed charges,,,33.6,,2.18,1.09,6.22,37,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,2.18,0.92,4.8,391,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,50,,3,1,9,80,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,1.16,1.16,1.37,16,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,0.4,0.4,0.4,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,0.19,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",0.19,448,,facility
ASSAY OF MANGANESE,83785,CPT,301,RC,,,,outpatient,,,308,30.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,26.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,55.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,28.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,23.7,23.7,23.7,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,26.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,28.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,53.15,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,27.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,26.65,448,,facility
"INJ., RITUXIMAB, 10 MG",J9312,HCPCS,636,RC,,,,outpatient,,,390,39,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,73.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,73.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,73.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,153.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,77.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,73.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,77.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,164.97,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,74.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,73.28,448,,facility
INTERMEDIATE REPAIR OF WOUND OF FACE; EARS; EYELIDS; NOSE; LIPS; OR MOUTH; 5.1-7.5 CM,12053,CPT,0450,RC,,,,outpatient,,,1026,102.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,350.55,350.55,350.55,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,400.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,813.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,412.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,366.07,366.07,366.07,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,412.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,396.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,389.05,1173,,facility
INJ FERRIC CARBOXYMALTOS 1MG,J1439,HCPCS,636,RC,,,,outpatient,,,6,0.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,1.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,2.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2.39,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,1.13,448,,facility
SHEATH BELOW KNEE,L8400,HCPCS,274,RC,,,,outpatient,,,30,3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,66,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,61,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,40.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,20.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,20.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,19.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,19.27,40.27,,facility
APPLICATION OF ULTRAVIOLET LIGHT TO SKIN,96900,CPT,0940,RC,,,,outpatient,,,111,11.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,34.44,34.44,37.34,114,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,74.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,418,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,36.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.74,448,,facility
CONVERSION OF STOMACH TUBE TO TUBE IN MIDDLE SMALL BOWEL USING AN ENDOSCOPE,44373,CPT,0750,RC,,,,outpatient,,,8621,862.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,1836.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1836.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1891.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1836.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3838.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1946.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1836.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1946.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3821,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1873.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3838.31,,facility
FUNGUS NES ANTIBODY,86671,CPT,302,RC,,,,outpatient,,,50,5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.48,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.25,448,,facility
CLOSED TREATMENT OF BROKEN FOREARM (RADIUS) BONE AT THE WRIST AREA ON THE THUMB SIDE OF THE WRIST WITHOUT MANIPULATION,25600,CPT,0450,RC,,,,outpatient,,,626,62.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,243.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,493.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,240.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,236.08,1173,,facility
INJECTION OR INFUSION INTO A VEIN OR ARTERY FOR THERAPY; PREVENTION; OR DIAGNOSIS,96379,CPT,0260,RC,,,,outpatient,,,149,14.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,44.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,44.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,46.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,44.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,93.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,47.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,44.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,47.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,427,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,45.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,44.82,448,,facility
MYELIN BASIC PROTEIN (NERVE PROTEIN) LEVEL; SPINAL FLUID,83873,CPT,0301,RC,,,,outpatient,,,245,24.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,35.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.3,15.3,15.3,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,37.17,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.2,448,,facility
ONDANSETRON ORAL,Q0162,HCPCS,636,RC,,,,outpatient,,,2,0.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.78,11.78,11.78,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,52.8,,44.53,13.31,44.69,153,percent of total billed charges,,,33.6,,26.2,13.1,44.53,29,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,26.29,13.31,44.53,72,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,50,,39,19.63,39.13,26,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,16.43,16.43,19.63,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",448,448,,facility
PHENOTYPE INFECT AGENT DRUG,87900,CPT,306,RC,,,,outpatient,,,586,58.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,130.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,130.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,134.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,130.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,272.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,138.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,130.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,138.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,281.61,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,132.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,130.35,448,,facility
MOD SED SAME PHYS/QHP EA,99153,CPT,370,RC,,,,outpatient,,,882,88.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,564.48,564.48,564.48,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,52.8,,592.7,396.02,1188.05,20,percent of total billed charges,,,33.6,,592.7,592.7,1089.14,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,299,296.35,1778.11,11,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,50,,882,882,882,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,379.3,138.52,882,36,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",448,448,,facility
SIMPLE CHANGE OF BLADDER TUBE,51705,CPT,0450,RC,,,,outpatient,,,847,84.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,239.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,239.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,246.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,239.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,499.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,253.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,239.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,253.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,243.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,239.12,1173,,facility
ANALYSIS FOR ANTIBODY TO HISTOPLASMA (FUNGUS),86698,CPT,0302,RC,,,,outpatient,,,175,17.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.27,12.27,12.27,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,28.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.27,12.27,12.27,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.79,448,,facility
HELMINTH ANTIBODY,86682,CPT,302,RC,,,,outpatient,,,108,10.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.57,11.57,11.57,36,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,56.78,56.78,66.44,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.57,11.57,11.57,12,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.11,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.01,448,,facility
IMMUNOASSAY QUANT NOS NONAB,83520,CPT,301,RC,,,,outpatient,,,73,7.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,36,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,66.08,66.08,66.08,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,41.18,24.82,318.38,1 through 10,percent of total billed charges,,,33.6,,37.63,37.63,96.43,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,33.6,23.18,176.4,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,36.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,87,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.22,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.27,448,,facility
"ALBUMIN (HUMAN),5%, 50ML",P9041,HCPCS,636,RC,,,,outpatient,,,208,20.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,10.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,22.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,10.62,448,,facility
ASSAY OF CALCIUM IN URINE,82340,CPT,301,RC,,,,outpatient,,,46,4.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.36,5.36,5.36,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,19.15,19.15,123.98,1 through 10,percent of total billed charges,,,33.6,,123.98,123.98,123.98,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,19.15,19.15,19.15,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,12.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.36,5.36,5.36,54,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.02,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,6.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,6.03,448,,facility
QUANTITATIVE ASSAY DRUG,80299,CPT,301,RC,,,,outpatient,,,178,17.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,13,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,174.64,174.64,174.64,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,171.6,171.6,171.6,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,374.52,374.52,374.52,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.62,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.64,448,,facility
RSV MAB IM 50MG,90378,CPT,636,RC,,,,outpatient,,,2548,254.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,436.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,436.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,449.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,436.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,912.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,462.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,436.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,462.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1547.72,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,445.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,436.75,1547.72,,facility
OPIATES 1 OR MORE,80361,CPT,301,RC,,,,outpatient,,,182,18.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
AQUATIC THERAPY/EXERCISES,97113,CPT,420,RC,,,,outpatient,,,195,19.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,51.96,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,89.84,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,80,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,34.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,34.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,34.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,72.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,36.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,34.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,36.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,422,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,34.79,448,,facility
IMMUNOASSAY QUANT NOS NONAB,83520,CPT,301,RC,,,,outpatient,,,362,36.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,36,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,66.08,66.08,66.08,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,41.18,24.82,318.38,1 through 10,percent of total billed charges,,,33.6,,37.63,37.63,96.43,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,33.6,23.18,176.4,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,36.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,87,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.22,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.27,448,,facility
IMMUNOLOGIC ANALYSIS TECHNIQUE ON SERUM (IMMUNOFIXATION),86334,CPT,0302,RC,,,,outpatient,,,82,8.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.87,19.87,19.87,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,23.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,14.26,14.26,56.5,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,27.8,8.98,35.95,1 through 10,percent of total billed charges,,,34.6,,38.84,31.24,40.77,11,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,46.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,23.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.87,19.87,19.87,37,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,23.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,48.28,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,22.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,22.34,448,,facility
CARDIOLIPIN ANTIBODY (TISSUE ANTIBODY) MEASUREMENT,86147,CPT,0302,RC,,,,outpatient,,,205,20.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,22.64,22.64,22.64,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,72.86,42.34,163.68,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,50.06,50.06,137.76,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,25.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,53.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,26.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,22.64,22.64,22.64,31,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,25.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,26.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,54.99,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,25.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,25.45,448,,facility
DRUG SCREENING FENTANYL,80354,CPT,301,RC,,,,outpatient,,,969,96.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
"ALBUMIN (HUMAN), 5%, 250 ML",P9045,HCPCS,636,RC,,,,outpatient,,,247,24.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,53.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,53.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,54.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,176.6,176.6,176.6,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,53.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,110.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,56.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,53.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,56.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,114.12,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,54.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,53.08,448,,facility
IMMUNOASSAY QUANT NOS NONAB,83520,CPT,301,RC,,,,outpatient,,,323,32.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,36,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,66.08,66.08,66.08,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,41.18,24.82,318.38,1 through 10,percent of total billed charges,,,33.6,,37.63,37.63,96.43,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,33.6,23.18,176.4,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,36.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,87,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.22,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.27,448,,facility
INJECTION OF ANESTHETIC AGENT AND/OR STEROID INTO FACE NERVE,64400,CPT,0450,RC,,,,outpatient,,,787,78.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,293.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,293.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,302.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,293.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,613.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,311.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,293.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,311.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,299.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,293.77,1173,,facility
IPILIMUMAB INJECTION,J9228,HCPCS,636,RC,,,,outpatient,,,693,69.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,190.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,190.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,196.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,190.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,398,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,201.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,190.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,201.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,387.11,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,194.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,190.43,448,,facility
CELL EXAMINATION OF SPECIMEN; CONCENTRATION TECHNIQUE,88108,CPT,0311,RC,,,,outpatient,,,411,41.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,263.04,263.04,263.04,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,74.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,86.31,86.31,86.31,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,39.1,39.1,39.1,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,55.65,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,36.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.74,448,,facility
DETECT AGENT NOS DNA QUANT,87799,CPT,306,RC,,,,outpatient,,,513,51.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,38.11,38.11,38.11,39,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,44.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,200.64,91.44,597.79,1 through 10,percent of total billed charges,,,33.6,,203.95,203.95,203.95,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,231.27,203.95,231.27,11,percent of total billed charges,,,34.6,,220.34,220.34,231.27,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,89.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,45.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,38.11,38.11,38.11,221,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,45.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,92.54,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,43.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,42.84,448,,facility
RBC OSMOTIC FRAGILITY,85557,CPT,305,RC,,,,outpatient,,,156,15.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.86,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.36,448,,facility
CT LWR EXTREMITY W/O&W/DYE,73702,CPT,352,RC,,,,outpatient,,,9245,924.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,403,,,,,,,case rate,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,371,,,,,,,case rate,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,875,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1050,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,172.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,350.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,177.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,177.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1522,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,171.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,167.87,1522,,facility
KRAS GENE VARIANTS EXON 2,81275,CPT,310,RC,,,,outpatient,,,760,76,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,193.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,193.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,199.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,193.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,403.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,204.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,193.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,204.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,338.19,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,197.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,193.25,448,,facility
IMMUNOASSAY TUMOR CA 19-9,86301,CPT,302,RC,,,,outpatient,,,243,24.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,18.51,18.51,18.51,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,128.41,40.13,163.31,1 through 10,percent of total billed charges,,,33.6,,96.1,96.1,96.1,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,96.1,25.54,96.95,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,20.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,43.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,60.06,60.06,60.06,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,18.51,18.51,18.51,16,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,20.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,44.98,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,21.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,20.81,448,,facility
ASSAY OF FERRITIN,82728,CPT,301,RC,,,,outpatient,,,554,55.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.12,12.12,12.12,348,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,56.64,56.64,185.26,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,50.69,32.26,165.79,96,percent of total billed charges,,,33.6,,32.26,32.26,165.79,18,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,32.26,32.26,105.5,115,percent of total billed charges,,,34.6,,116.18,116.18,116.18,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,28.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,48,48,48,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,65.94,20.16,65.94,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.12,12.12,12.12,882,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.45,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.63,448,,facility
FLUORESCENT ANTIBODY TITER,86256,CPT,302,RC,,,,outpatient,,,379,37.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.72,10.72,10.72,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.04,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.05,448,,facility
HEMATOCRIT,85014,CPT,305,RC,,,,outpatient,,,19,1.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,2.11,2.11,2.11,26,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,12.16,12.16,78.72,14,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,3.32,3.32,11.21,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,68.24,41.33,70.23,31,percent of total billed charges,,,33.6,,10.03,10.03,41.33,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,41.33,6.38,41.7,26,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,4.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,61.5,9.5,61.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,2.11,2.11,2.11,164,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.13,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,2.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,2.37,448,,facility
IMMUNFIX E-PHORSIS/URINE/CSF,86335,CPT,302,RC,,,,outpatient,,,236,23.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,26.11,26.11,26.11,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,25.76,25.76,25.76,1 through 10,percent of total billed charges,,,34.6,,56.99,56.99,56.99,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,29.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,61.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,31.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,26.11,26.11,26.11,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,29.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,31.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,63.4,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,29.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,29.35,448,,facility
TRANSCORTIN (CORTISOL BINDING PROTEIN) LEVEL,84449,CPT,0301,RC,,,,outpatient,,,60,6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,37.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.89,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18,448,,facility
COL CHROMOTOGRAPHY QUAL/QUAN,82542,CPT,301,RC,,,,outpatient,,,956,95.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,21.43,21.43,21.43,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,435.07,435.07,435.07,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,24.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,50.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,25.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,21.43,21.43,21.43,15,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,24.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,25.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.16,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,24.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,24.09,448,,facility
COMPLEMENT/FUNCTION ACTIVITY,86161,CPT,302,RC,,,,outpatient,,,110,11,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.92,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12,448,,facility
EMERGENCY DEPARTMENT VISIT FOR PROBLEM OF MILD SEVERITY,99281,CPT,0450,RC,,,,outpatient,,,615,61.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,77.25,74.44,77.25,283,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,223,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,691,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,227,227,227,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,218,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1200,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1500,,,,,,,case rate,NTE Percentage + Reimbursement Rate 85.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,80.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,80.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,368.87,217.06,368.87,15,percent of total billed charges,,,33.6,,368.87,368.87,368.87,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,208.49,16.44,234.5,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,80.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,168.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,85.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,78.41,75.93,78.41,270,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,80.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,85.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,450,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,82.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,80.7,1500,,facility
DETECTION OF ANTIMICROBIAL DRUG (ANTIBIOTIC; ANTIFUNGAL; ANTIVIRAL),87185,CPT,0306,RC,,,,outpatient,,,147,14.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.23,4.23,4.23,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,9.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.23,4.23,4.23,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.26,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,4.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,4.75,448,,facility
HSV DNA QUANT,87530,CPT,306,RC,,,,outpatient,,,175,17.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,44.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,89.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,45.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,45.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,92.54,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,43.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,42.84,448,,facility
IMMUNOASSAY QUANT NOS NONAB,83520,CPT,301,RC,,,,outpatient,,,288,28.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,36,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,66.08,66.08,66.08,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,41.18,24.82,318.38,1 through 10,percent of total billed charges,,,33.6,,37.63,37.63,96.43,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,33.6,23.18,176.4,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,36.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,87,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.22,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.27,448,,facility
INJECTION OF CONTRAST FOR IMAGING OF HIP JOINT,27093,CPT,0361,RC,,,,outpatient,,,905,90.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,55.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,55.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,57.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,55.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,116.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,58.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,55.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,58.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2440,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,56.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,55.56,2440,,facility
QUANTITATIVE ASSAY DRUG,80299,CPT,301,RC,,,,outpatient,,,168,16.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,13,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,174.64,174.64,174.64,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,171.6,171.6,171.6,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,374.52,374.52,374.52,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.62,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.64,448,,facility
FLUORESCENT ANTIBODY TITER,86256,CPT,302,RC,,,,outpatient,,,378,37.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.72,10.72,10.72,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.04,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.05,448,,facility
BCR/ABL1 GENE MAJOR BP,81206,CPT,310,RC,,,,outpatient,,,747,74.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,145.84,145.84,145.84,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,163.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,163.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,168.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,163.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,342.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,173.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,358.89,358.89,358.89,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,163.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,173.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,354.24,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,167.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,163.96,448,,facility
ABOVE KNEE FLEX COVER SYSTEM,L5964,HCPCS,274,RC,,,,outpatient,,,1701,170.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,66,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,61,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1146.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1146.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1180.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1146.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,2396.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1215.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1146.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1215.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,1169.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,1146.54,2396.27,,facility
CHLAMYDIA IGM ANTIBODY,86632,CPT,302,RC,,,,outpatient,,,35,3.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,26.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.41,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.68,448,,facility
BACTERIUM ANTIBODY,86609,CPT,302,RC,,,,outpatient,,,232,23.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,26.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.88,448,,facility
DNA TESTING FOR GENETIC DEFECTS,88271,CPT,0311,RC,,,,outpatient,,,474,47.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.05,19.05,19.05,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,1274.11,1274.11,1274.11,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,477.79,477.79,477.79,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,21.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,44.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.05,19.05,19.05,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,21.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,46.27,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,21.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,21.42,448,,facility
HO FLEX FREJKA W/COV PRE CST,L1600,HCPCS,274,RC,,,,outpatient,,,294,29.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,66,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,61,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,197.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,197.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,203.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,197.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,412.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,209.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,197.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,209.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,201.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,197.44,412.65,,facility
NORMAL SALINE SOLUTION INFUS,J7040,HCPCS,636,RC,,,,outpatient,,,8,0.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,5.12,5.12,5.12,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,52.8,,4.22,2.69,8.45,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,2.97,2.67,2.97,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",448,448,,facility
TESTOSTERONE (HORMONE) LEVEL; FREE,84402,CPT,0301,RC,,,,outpatient,,,92,9.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,22.66,22.66,22.66,39,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,54.28,54.28,54.28,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,48.58,20.59,48.58,16,percent of total billed charges,,,33.6,,123.65,123.65,123.65,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,30.91,13.1,31.19,15,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,25.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,53.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,19.32,19.32,19.32,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,22.66,22.66,22.66,50,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,25.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,55.04,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,25.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,25.47,448,,facility
COL CHROMOTOGRAPHY QUAL/QUAN,82542,CPT,301,RC,,,,outpatient,,,1397,139.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,21.43,21.43,21.43,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,435.07,435.07,435.07,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,24.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,50.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,25.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,21.43,21.43,21.43,15,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,24.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,25.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.16,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,24.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,24.09,448,,facility
HIGH DOSE RADIATION THERAPY; 1 CHANNEL,77770,CPT,0342,RC,,,,outpatient,,,3768,376.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,666.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,666.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,686.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,666.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1393.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,706.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,666.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,706.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1945,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,679.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1945,,facility
SIMPLE SEPARATION OF FINGERNAIL OR TOENAIL FROM NAIL BED; FIRST NAIL,11730,CPT,0450,RC,,,,outpatient,,,1584,158.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,197.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,401.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,203.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,180.67,180.67,180.67,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,203.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,195.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,192.01,1173,,facility
FT PROSTH MULTIAXIAL ANKL/FT,L5978,HCPCS,274,RC,,,,outpatient,,,614,61.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,66,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,61,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,416.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,416.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,429.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,416.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,870.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,441.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,416.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,441.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,424.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,416.66,870.82,,facility
COCCIDIOIDES ANTIBODY,86635,CPT,302,RC,,,,outpatient,,,231,23.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,107.18,107.18,107.18,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,23.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.2,10.2,10.2,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.8,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,11.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.47,448,,facility
ANGIOTENSIN I ENZYME TEST,82164,CPT,301,RC,,,,outpatient,,,527,52.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.99,12.99,12.99,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,42.67,12.77,67.06,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,42.88,42.88,42.88,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,30.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.99,12.99,12.99,26,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,31.55,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.6,448,,facility
INJECTION OF BLOOD OR BLOOD CLOT INTO SPINAL CANAL,62273,CPT,0361,RC,,,,outpatient,,,3364,336.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,623.15,623.15,623.15,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,675.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,675.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,695.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,675.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1411.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,716.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,616.7,616.7,616.7,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,675.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,716.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2712,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,689.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,2712,,facility
FLOW CYTOMETRY TECHNIQUE FOR DNA OR CELL ANALYSIS; EACH ADDITIONAL MARKER,88185,CPT,0311,RC,,,,outpatient,,,838,83.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,456.96,430.08,1705.1,168,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,52.8,,399.84,399.84,2815.68,17,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,1759.8,1759.8,1759.8,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.72,18.35,330.3,23,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,53.55,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",53.55,448,,facility
CT SCAN OF PELVIS WITHOUT CONTRAST,72192,CPT,0352,RC,,,,outpatient,,,5135,513.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,93.3,93.3,93.3,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,411,411,411,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,875,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1050,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,1725.36,1725.36,1725.36,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,1725.36,1725.36,1725.36,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,67.98,67.98,67.98,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1522,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,1522,,facility
IMMUNOASSAY QUANT NOS NONAB,83520,CPT,301,RC,,,,outpatient,,,428,42.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,36,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,66.08,66.08,66.08,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,41.18,24.82,318.38,1 through 10,percent of total billed charges,,,33.6,,37.63,37.63,96.43,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,33.6,23.18,176.4,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,36.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,87,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.22,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.27,448,,facility
AGENT NOS ASSAY W/OPTIC,87899,CPT,306,RC,,,,outpatient,,,33,3.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,33.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,14.29,14.29,14.29,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.12,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,16.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,16.07,448,,facility
ONDANSETRON HCL INJECTION,J2405,HCPCS,636,RC,,,,outpatient,,,4,0.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,3.23,2.55,20.48,234,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,2.36,2.36,8.67,28,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,52.8,,1.8,1.19,3.18,794,percent of total billed charges,,,33.6,,1.34,0.85,3.08,99,percent of total billed charges,,,58.2,,1.34,1.34,1.34,1 through 10,percent of total billed charges,,,33.6,,1.81,0.67,3.7,805,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,50,,2,2,3.68,137,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,0.84,0.84,0.84,16,percent of total billed charges,,,35,,1.48,1.48,1.48,1 through 10,percent of total billed charges,,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,0.6,0.6,0.6,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",448,448,,facility
ENCEPHALTIS EAST EQNE ANBDY,86652,CPT,302,RC,,,,outpatient,,,52,5.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.49,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.19,448,,facility
ROTAVIRUS AG IA,87425,CPT,306,RC,,,,outpatient,,,237,23.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.9,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.98,448,,facility
CLOTTING FACTOR INHIBITOR TEST,85335,CPT,0305,RC,,,,outpatient,,,1015,101.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.45,11.45,11.45,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,598.85,598.85,598.85,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,26.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.45,11.45,11.45,14,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.81,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.87,448,,facility
SC STD AGAR DILUTION PER AGT,87181,CPT,306,RC,,,,outpatient,,,330,33,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,9.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.26,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,4.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,4.75,448,,facility
CT SCAN OF CRANIAL CAVITY BEFORE AND AFTER CONTRAST,70482,CPT,0351,RC,,,,outpatient,,,9418,941.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,403,,,,,,,case rate,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,371,,,,,,,case rate,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,875,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1050,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,172.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,350.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,177.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,177.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1522,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,171.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,167.87,1522,,facility
TEST SOCKET KNEE DISARTICULA,L5622,HCPCS,274,RC,,,,outpatient,,,878,87.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,66,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,61,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,591.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,591.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,609.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,591.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1236.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,627.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,591.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,627.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,603.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,591.76,1236.78,,facility
DESTRUCTION OF FACE NERVE BRANCH UNDER X-RAY MONITORING,64610,CPT,0361,RC,,,,outpatient,,,7826,782.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,1868.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1868.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1924.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1868.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3905.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1981,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1868.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1981,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9389,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1906.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,9389,,facility
CFTR GENE FULL SEQUENCE,81223,CPT,310,RC,,,,outpatient,,,2490,249,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,499,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,499,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,513.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,499,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1042.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,528.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,499,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,528.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,873.25,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,508.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1042.91,,facility
REMOVAL OF FOREIGN BODIES OF ESOPHAGUS; STOMACH; AND/OR UPPER SMALL BOWEL USING A FLEXIBLE ENDOSCOPE,43247,CPT,0750,RC,,,,outpatient,,,4009,400.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,753.36,753.36,753.36,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,868.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,868.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,894.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,2180.79,2180.79,2180.79,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,868.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1814.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,920.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,816.74,0.14,834.91,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,868.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,920.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3821,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,885.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3821,,facility
ENTAMOEB HIST GROUP AG IA,87337,CPT,306,RC,,,,outpatient,,,155,15.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.9,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.98,448,,facility
IMMUNOASSAY QUANT NOS NONAB,83520,CPT,301,RC,,,,outpatient,,,599,59.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,36,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,66.08,66.08,66.08,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,41.18,24.82,318.38,1 through 10,percent of total billed charges,,,33.6,,37.63,37.63,96.43,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,33.6,23.18,176.4,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,36.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,87,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.22,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.27,448,,facility
INTERMEDIATE REPAIR OF WOUND OF FACE; EARS; EYELIDS; NOSE; LIPS; OR MOUTH; 7.6-12.5 CM,12054,CPT,0450,RC,,,,outpatient,,,1108,110.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,400.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,813.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,412.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,412.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,396.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,389.05,1311,,facility
QUANTITATIVE ASSAY DRUG,80299,CPT,301,RC,,,,outpatient,,,84,8.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,13,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,174.64,174.64,174.64,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,171.6,171.6,171.6,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,374.52,374.52,374.52,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.62,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.64,448,,facility
CARCINOEMBRYONIC ANTIGEN,82378,CPT,301,RC,,,,outpatient,,,86,8.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.86,16.86,16.86,25,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,89.04,28.9,139.92,41,percent of total billed charges,,,33.6,,89.04,28.9,89.04,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,28.9,28.9,89.04,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,39.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,20.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,132.5,132.5,132.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.86,16.86,16.86,36,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,20.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,40.97,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.96,448,,facility
DRUG SCREENING TRAMADOL,80373,CPT,301,RC,,,,outpatient,,,339,33.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
ASSAY ALKALINE PHOSPHATASES,84080,CPT,301,RC,,,,outpatient,,,193,19.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.15,13.15,13.15,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,12.43,12.43,12.43,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,12.43,12.43,12.54,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,30.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.15,13.15,13.15,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,31.94,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,15.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.78,448,,facility
BIOPSY OF RELATED SKIN GROWTH; EACH ADDITIONAL GROWTH,11103,CPT,0761,RC,,,,outpatient,,,186,18.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,35.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3500.76,3500.76,3500.76,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,17.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,16.98,1173,,facility
UPR/L XTREMITY ART 2 LEVELS,93922,CPT,921,RC,,,,outpatient,,,1741,174.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,131.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,266.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,134.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,134.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1227,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,129.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,127.33,1227,,facility
COL CHROMOTOGRAPHY QUAL/QUAN,82542,CPT,301,RC,,,,outpatient,,,876,87.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,21.43,21.43,21.43,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,435.07,435.07,435.07,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,24.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,50.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,25.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,21.43,21.43,21.43,15,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,24.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,25.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.16,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,24.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,24.09,448,,facility
SINGLE CONTRAST X-RAY OF UPPER DIGESTIVE TRACT,74240,CPT,0320,RC,,,,outpatient,,,1633,163.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,1045.12,1045.12,1045.12,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,172.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,862.22,862.22,862.22,1 through 10,percent of total billed charges,,,33.6,,553.59,553.59,553.59,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,548.69,548.69,553.59,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,350.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,177.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,816.5,816.5,816.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,70.79,66.9,70.79,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,177.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,171.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,167.87,448,,facility
BRUCELLA ANTIBODY,86622,CPT,302,RC,,,,outpatient,,,139,13.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,18.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,9.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,7.94,7.94,7.94,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,9.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.3,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,9.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,8.93,448,,facility
THYROID HORMONE; T3 MEASUREMENT; REVERSE,84482,CPT,0301,RC,,,,outpatient,,,57,5.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,14.02,14.02,14.02,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,32.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,34.06,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,16.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,15.76,448,,facility
X-RAY OF HAND; 2 VIEWS,73120,CPT,0320,RC,,,,outpatient,,,490,49,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,18.87,18.87,18.87,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,448,,facility
NUCLEAR ANTIGEN ANTIBODY,86235,CPT,302,RC,,,,outpatient,,,270,27,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13,12.5,15.95,11,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,54.91,4.37,90.29,43,percent of total billed charges,,,33.6,,4.37,4.37,53.09,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,22.18,4.24,83.33,13,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,37.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.95,13,15.95,54,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.75,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.93,448,,facility
ASSAY OF THYROGLOBULIN,84432,CPT,301,RC,,,,outpatient,,,10,1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,14.29,14.29,14.29,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,5.9,5.9,33.04,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,5.28,3.36,29.57,1 through 10,percent of total billed charges,,,33.6,,14.58,14.58,18.82,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,14.58,3.36,18.82,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,33.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,14.29,10,14.29,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,34.7,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,16.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,16.06,448,,facility
DETECT AGENT NOS DNA QUANT,87799,CPT,306,RC,,,,outpatient,,,590,59,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,38.11,38.11,38.11,39,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,44.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,200.64,91.44,597.79,1 through 10,percent of total billed charges,,,33.6,,203.95,203.95,203.95,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,231.27,203.95,231.27,11,percent of total billed charges,,,34.6,,220.34,220.34,231.27,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,89.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,45.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,38.11,38.11,38.11,221,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,45.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,92.54,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,43.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,42.84,448,,facility
ASSAY OF GLUTATHIONE,82978,CPT,301,RC,,,,outpatient,,,176,17.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,32.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.8,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,15.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,15.45,448,,facility
FLUOROURACIL INJECTION,J9190,HCPCS,636,RC,,,,outpatient,,,126,12.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,90.44,56.22,1048.32,284,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,52.8,,45.9,45.21,67.13,130,percent of total billed charges,,,33.6,,41.93,7.28,45.29,231,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,7.33,4.89,29.6,113,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",448,448,,facility
MECHANICAL SEPARATION OF WHITE BLOOD CELLS AND PLATELETS FROM BLOOD,36522,CPT,0361,RC,,,,outpatient,,,20530,2053,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 6500.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 10000.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,4168.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4168.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4293.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4168.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,8712.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4418.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,9528.12,4764.06,9528.12,12,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4168.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4418.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10550,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,4251.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,10550,,facility
TEST TO MEASURE RATE OF AIRFLOW,94375,CPT,0460,RC,,,,outpatient,,,651,65.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,206.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,206.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,212.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,206.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,431.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,219.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,20.21,20.21,20.8,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,206.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,219.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,611,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,210.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,206.65,611,,facility
BK FLEX INNER SOCKET EXT FRA,L5645,HCPCS,274,RC,,,,outpatient,,,1453,145.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,66,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,61,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,978.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,978.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1008.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,978.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,2045.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1037.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,978.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1037.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,998.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,978.8,2045.69,,facility
PMS2 GENE FULL SEQ ANALYSIS,81317,CPT,310,RC,,,,outpatient,,,684,68.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,676.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,676.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,696.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,676.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1413.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,717.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,676.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,717.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1237.29,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,690.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1413.88,,facility
ENDO BELOW KNEE ALIGNABLE SY,L5910,HCPCS,274,RC,,,,outpatient,,,877,87.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,66,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,61,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,591.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,591.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,608.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,591.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1235.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,626.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,591.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,626.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,603.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,591.19,1235.59,,facility
SIMPLE REMOVAL OF FOREIGN BODY; STONE; OR STENT IN URETHRA OR BLADDER USING AN ENDOSCOPE,52310,CPT,0761,RC,,,,outpatient,,,5513,551.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,1797.37,1797.37,1824.23,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2000.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2000.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2060.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2000.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,4181.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2120.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,1824.23,1824.23,1824.23,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2000.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2120.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,4056.52,4056.52,4056.52,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,2040.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,4181.3,,facility
PATHOLOGY EXAMINATION OF TISSUE USING A MICROSCOPE; MODERATELY HIGH COMPLEXITY,88307,CPT,0310,RC,,,,outpatient,,,919,91.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,316.43,315.62,343.05,13,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,588.16,588.16,588.16,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,343.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,343.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,353.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,412.63,308.78,617.57,16,percent of total billed charges,,,33.6,,308.78,308.78,926.35,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,308.78,308.78,617.57,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,343.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,716.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,363.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,459.5,459.5,459.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,192.99,192.99,385.98,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,168.02,168.02,174.02,77,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,343.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,363.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,377,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,349.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,343.05,716.97,,facility
QUANTITATIVE ASSAY DRUG,80299,CPT,301,RC,,,,outpatient,,,327,32.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,13,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,174.64,174.64,174.64,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,171.6,171.6,171.6,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,374.52,374.52,374.52,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.62,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.64,448,,facility
MOPATH PROCEDURE LEVEL 4,81403,CPT,310,RC,,,,outpatient,,,193,19.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,185.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,185.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,190.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,322.39,322.39,322.39,1 through 10,percent of total billed charges,,,34.6,,397.12,397.12,397.12,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,185.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,387.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,196.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,185.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,196.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,324.1,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,188.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,185.2,448,,facility
FLUORESCENT ANTIBODY SCREEN,86255,CPT,302,RC,,,,outpatient,,,112,11.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.72,10.72,10.72,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,45.41,28.9,1068.67,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,28.9,28.9,28.9,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.72,10.72,10.72,19,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.04,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.05,448,,facility
ACUTE HEPATITIS PANEL,80074,CPT,0302,RC,,,,outpatient,,,542,54.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,42.37,42.37,42.37,53,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,102.07,102.07,319.78,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,47.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,47.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,49.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,91.34,58.13,309.48,14,percent of total billed charges,,,33.6,,91.48,91.48,91.48,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,58.13,58.13,58.73,15,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,47.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,99.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,50.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,42.37,42.37,42.37,95,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,47.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,50.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,102.92,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,48.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,47.63,448,,facility
DIAGNOSTIC MAMMOGRAPHY OF BOTH BREASTS,77066,CPT,0401,RC,,,,outpatient,,,489,48.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,161.31,161.31,161.31,33,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,161.31,161.31,375.24,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,225,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,250,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,44.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,44.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,46.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,318,213.7,335.81,31,percent of total billed charges,,,33.6,,318,213.7,318,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,213.7,165.77,318,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,44.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,93.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,47.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,133.56,133.56,318,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,44.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,47.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,429,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,45.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,44.73,448,,facility
IMMUNE COMPLEX MEASUREMENT,86332,CPT,0302,RC,,,,outpatient,,,76.5,7.65,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,24.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,50.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,25.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,24.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,25.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,52.66,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,24.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,24.37,448,,facility
DNA/RNA DIRECT PROBE,87149,CPT,306,RC,,,,outpatient,,,15,1.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,20.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,41.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,21.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,20.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,21.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,43.33,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,20.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,20.05,448,,facility
DETECT AGENT NOS DNA AMP,87798,CPT,306,RC,,,,outpatient,,,185,18.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,110.88,110.88,174.24,1 through 10,percent of total billed charges,,,33.6,,244.27,244.27,244.27,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,96.77,32.38,119.79,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,38.9,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
GENE ANALYSIS (NUCLEOPHOSMIN) EXON 12 VARIANTS,81310,CPT,0310,RC,,,,outpatient,,,1163,116.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,219.28,219.28,219.28,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,246.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,246.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,253.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,246.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,515.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,261.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,246.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,261.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,431.41,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,251.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,246.52,515.23,,facility
URINALYSIS NONAUTO W/O SCOPE,81002,CPT,307,RC,,,,outpatient,,,110,11,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.1,3.1,3.1,63,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,7.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.1,3.1,3.1,277,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.09,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,3.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,3.48,448,,facility
SMOKING AND TOBACCO USE INTENSIVE COUNSELING; MORE THAN 10 MINUTES,99407,CPT,0942,RC,,,,outpatient,,,232,23.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,26.14,26.14,26.14,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,74.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,38.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,21.52,21.52,21.52,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,38.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,232,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,36.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.86,448,,facility
CT SCAN OF BLOOD VESSELS OF PELVIS WITH CONTRAST,72191,CPT,0352,RC,,,,outpatient,,,4490,449,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,411,411,411,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,875,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1050,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,172.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,350.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,177.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,177.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1522,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,171.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,167.87,1522,,facility
CREATION OF FLAP GRAFT TO NOSE; FOREHEAD; TEMPLE; OR SCALP,15731,CPT,0761,RC,,,,outpatient,,,3201,320.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1027,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1519,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3391.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3391.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3493.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3391.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,7088.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3595.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3391.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3595.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,3459.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,7088.34,,facility
ASSAY OF URINE SODIUM,84300,CPT,301,RC,,,,outpatient,,,87,8.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.5,4.5,4.5,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,62.16,62.16,62.72,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,10.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,21.5,21.5,92.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.5,4.5,4.5,20,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.5,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.06,448,,facility
ASSAY OF VOLATILES,84600,CPT,301,RC,,,,outpatient,,,50,5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,35.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,34.74,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.11,448,,facility
INSERTION OF STOMACH TUBE USING A FLEXIBLE ENDOSCOPE,43246,CPT,0750,RC,,,,outpatient,,,7837,783.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,1664.42,1558.21,1689.3,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,1836.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1836.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1891.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1836.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3838.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1946.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,1689.3,1689.3,1727.99,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1836.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1946.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3821,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1873.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3838.31,,facility
GENE ANALYSIS (MYELOID DIFFERENTIATION PRIMARY RESPONSE 88) FOR P.LEU265PRO VARIANT,81305,CPT,0310,RC,,,,outpatient,,,1169,116.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,175.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,175.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,180.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,175.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,366.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,185.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,175.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,185.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,306.95,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,178.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,175.4,448,,facility
DRESSING CHANGE OR REMOVAL OF BURN TISSUE; 5-10% OF TOTAL BODY SURFACE,16025,CPT,0450,RC,,,,outpatient,,,632,63.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,174.34,163.22,174.34,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,197.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,401.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,203.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,203.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,195.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,192.01,1311,,facility
UNLISTED CHEMISTRY PROCEDURE,84999,CPT,301,RC,,,,outpatient,,,730,73,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
GENE ANALYSIS (JANUS KINASE 2) VARIANT,81270,CPT,0310,RC,,,,outpatient,,,350,35,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,91.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,91.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,94.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,297.36,297.36,297.36,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,91.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,191.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,97.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,175,175,175,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,81.53,81.53,81.53,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,91.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,97.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,198.05,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,93.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,91.66,448,,facility
CLOSED TREATMENT OF BROKEN OUTSIDE LOWER LEG BONE AT ANKLE WITH MANIPULATION,27788,CPT,0450,RC,,,,outpatient,,,3201,320.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,243.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,493.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,213.62,213.62,213.62,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,240.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,236.08,1173,,facility
ADMINISTRATION OF ADDITIONAL NEW DRUG OR SUBSTANCE INTO VEIN USING PUSH TECHNIQUE,96411,CPT,0331,RC,,,,outpatient,,,615,61.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,62.45,58.46,119.62,203,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,393.6,362.85,393.6,22,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,68.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,68.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,70.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,324.72,208.49,324.72,1 through 10,percent of total billed charges,,,33.6,,206.64,206.64,206.64,16,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,206.64,206.64,208.49,19,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,68.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,144.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,73.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,63.38,63.38,126.76,99,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,68.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,73.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1603,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,70.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,68.91,1603,,facility
COLONOSCOPY W/LESION REMOVAL,45384,CPT,750,RC,,,,outpatient,,,5170,517,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1179.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,2393.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1213.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1213.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3821,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1168.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3821,,facility
KNEE-SHIN PNEUM SWG FRCT EXO,L5722,HCPCS,274,RC,,,,outpatient,,,1640,164,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,66,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,61,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1114.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1114.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1147.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1114.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,2328.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1180.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1114.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1180.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,1136.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,1114.06,2328.39,,facility
INJ NIVOL RELATLIMAB 3MG/1MG,J9298,HCPCS,636,RC,,,,outpatient,,,734,73.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,205.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,205.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,211.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,205.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,429.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,217.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,205.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,217.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,416.8,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,209.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,205.51,448,,facility
X-RAY OF UPPER SPINE; 2-3 VIEWS,72040,CPT,0320,RC,,,,outpatient,,,944,94.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,604.16,604.16,604.16,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,85.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,498.43,317.18,539.02,19,percent of total billed charges,,,33.6,,317.18,317.18,317.18,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,317.18,317.18,320.02,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,174.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,472,472,472,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,23.45,23.45,24.14,39,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,84.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,83.29,448,,facility
ASSAY OF LIDOCAINE,80176,CPT,301,RC,,,,outpatient,,,67,6.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,30.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,31.75,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.69,448,,facility
ALPHA-FETOPROTEIN (AFP) LEVEL; SERUM,82105,CPT,0301,RC,,,,outpatient,,,111,11.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,14.92,14.92,14.92,44,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,215.35,215.35,215.35,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,58.61,58.61,192.72,11,percent of total billed charges,,,33.6,,58.61,37.3,122.64,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,37.3,37.3,123.74,15,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,35.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,14.92,14.92,14.92,104,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.24,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,16.77,448,,facility
MSH2 GENE DUP/DELETE VARIANT,81297,CPT,310,RC,,,,outpatient,,,233,23.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,213.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,213.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,219.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,213.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,445.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,226.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,213.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,226.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,373.28,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,217.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,213.3,448,,facility
MICROSOMAL ANTIBODY EACH,86376,CPT,302,RC,,,,outpatient,,,254,25.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.94,12.94,12.94,22,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,22.18,14.11,82.9,1 through 10,percent of total billed charges,,,33.6,,22.51,22.51,22.51,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,22.51,11.27,81.98,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,30.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.94,12.94,12.94,63,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,31.43,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.55,448,,facility
CELL EXAMINATION OF SPECIMEN; SELECTIVE CELLULAR ENHANCEMENT TECHNIQUE,88112,CPT,0311,RC,,,,outpatient,,,89,8.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,46.88,46,49.87,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,56.96,56.96,56.96,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,49.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,49.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,51.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,120.62,29.9,189.55,1 through 10,percent of total billed charges,,,33.6,,29.9,29.9,120.62,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,49.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,104.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,52.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,75.39,75.39,75.39,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,33.17,33.17,34.41,11,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,49.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,52.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,78.23,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,50.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,49.87,448,,facility
CLOTTING FACTOR IX (PTC OR CHRISTMAS) MEASUREMENT,85250,CPT,0305,RC,,,,outpatient,,,143.5,14.35,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.94,16.94,16.94,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,76.03,48.38,76.03,1 through 10,percent of total billed charges,,,33.6,,48.38,48.38,48.38,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,39.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,20.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,72,72,72,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.94,16.94,16.94,24,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,20.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,41.14,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,19.04,448,,facility
RBC ANTIBODY IDENTIFICATION,86870,CPT,302,RC,,,,outpatient,,,548,54.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,315.62,315.62,343.05,52,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,343.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,343.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,353.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,289.34,289.34,578.69,17,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,198.92,198.92,596.77,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,343.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,716.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,363.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,23.42,23.42,46.84,19,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,343.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,363.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,377,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,349.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,343.05,716.97,,facility
SCREENING TEST FOR PATHOGENIC ORGANISMS,87081,CPT,0306,RC,,,,outpatient,,,282,28.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.9,5.9,5.9,191,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,192.64,5.9,192.64,17,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,277.89,277.89,277.89,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,148.9,101.14,158.93,15,percent of total billed charges,,,33.6,,148.9,101.14,158.93,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,101.14,95.6,101.14,34,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,13.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,7.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,150.5,141,150.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,63.21,63.21,63.21,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.9,5.9,5.9,279,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,7.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.32,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,6.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,6.63,448,,facility
REVIEW BY RADIOLOGIST OF LIVER VEIN IMAGE WITH ASSESSMENT OF BLOOD FLOW,75889,CPT,0320,RC,,,,outpatient,,,6285,628.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3021.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3021.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3112.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3021.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,6315.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3203.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3021.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3203.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,3082.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,443,6315.75,,facility
CULTURE AEROBIC IDENTIFY,87077,CPT,306,RC,,,,outpatient,,,44,4.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,7.19,7.19,7.19,67,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,101.48,25.96,101.48,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,90.82,57.79,154.46,34,percent of total billed charges,,,33.6,,57.79,53.5,90.82,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,57.79,14.92,58.31,28,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,16.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,86,86,172,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,36.12,36.12,36.12,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,7.19,7.19,7.19,240,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.45,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,8.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,8.08,448,,facility
ALKALOIDS LEVELS,80323,CPT,0301,RC,,,,outpatient,,,179,17.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
SWEAT COLLECTION,89230,CPT,0300,RC,,,,outpatient,,,108.75,10.88,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,46.88,46,46.88,15,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,69.6,69.6,69.76,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,49.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,49.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,51.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,49.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,104.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,52.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,2.41,2.41,2.47,19,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,49.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,52.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,78.23,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,50.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,49.87,448,,facility
ASSAY ALKALINE PHOSPHATASE,84075,CPT,301,RC,,,,outpatient,,,112,11.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.61,4.61,4.61,50,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,15.34,10.36,15.34,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,81,81,81,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,46.25,13.73,46.25,76,percent of total billed charges,,,33.6,,27.22,8.74,46.25,18,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,27.22,8.74,27.46,55,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,10.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,40.5,13,40.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,5.46,5.46,5.46,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.61,4.61,4.61,627,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.18,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.18,448,,facility
BELOW KNEE CUFF SUSPENSION,L5666,HCPCS,274,RC,,,,outpatient,,,170,17,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,66,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,61,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,114.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,114.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,117.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,114.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,238.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,121.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,114.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,121.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,116.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,114.26,238.8,,facility
GENE REARRANGEMENT ANALYSIS DETECTION ABNORMAL CLONAL POPULATION (T CELL ANTIGEN RECEPTOR GAMMA),81342,CPT,0310,RC,,,,outpatient,,,1981,198.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,179.23,179.23,179.23,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,201.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,201.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,207.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,201.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,421.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,213.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,201.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,213.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,435.33,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,205.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,201.5,448,,facility
ENZYME CELL ACTIVITY,82657,CPT,301,RC,,,,outpatient,,,1411,141.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.72,19.72,19.72,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,2094.14,2094.14,2094.14,1 through 10,percent of total billed charges,,,33.6,,762.96,762.96,762.96,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,46.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,23.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.72,19.72,19.72,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,23.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,39.01,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,22.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,22.17,448,,facility
X-RAY OF JOINT BETWEEN LOWER SPINE AND HIP BONE; 1-2 VIEWS,72200,CPT,0320,RC,,,,outpatient,,,633,63.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,448,,facility
NUCLEAR ANTIGEN ANTIBODY,86235,CPT,302,RC,,,,outpatient,,,175,17.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13,12.5,15.95,11,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,54.91,4.37,90.29,43,percent of total billed charges,,,33.6,,4.37,4.37,53.09,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,22.18,4.24,83.33,13,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,37.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.95,13,15.95,54,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.75,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.93,448,,facility
SC STD AGAR DILUTION PER AGT,87181,CPT,306,RC,,,,outpatient,,,416,41.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,9.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.26,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,4.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,4.75,448,,facility
CYP2C9 GENE COM VARIANTS,81227,CPT,310,RC,,,,outpatient,,,278.65,27.87,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,174.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,174.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,180.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,174.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,365.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,185.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,174.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,185.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,305.92,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,178.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,174.81,448,,facility
X-RAY OF FOOT; 2 VIEWS,73620,CPT,0320,RC,,,,outpatient,,,701,70.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,85.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,174.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.98,16.98,17.75,11,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,84.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,83.29,448,,facility
MICRODISSECTION MANUAL,88381,CPT,310,RC,,,,outpatient,,,279,27.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,93.74,93.74,93.74,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,21.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,44.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,21.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,172.62,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,21.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,21.51,448,,facility
QUANTITATIVE ASSAY DRUG,80299,CPT,301,RC,,,,outpatient,,,123,12.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,13,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,174.64,174.64,174.64,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,171.6,171.6,171.6,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,374.52,374.52,374.52,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.62,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.64,448,,facility
HIV-1 QUANT&REVRSE TRNSCRPJ,87536,CPT,306,RC,,,,outpatient,,,1158,115.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,75.7,75.7,75.7,61,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,115.05,115.05,369.93,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,124.8,124.8,124.8,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,85.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,85.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,87.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,102.96,65.52,102.96,24,percent of total billed charges,,,33.6,,102.96,65.52,331.06,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,65.52,65.52,66.11,15,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,85.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,177.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,90.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,97.5,97.5,97.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,75.7,75.7,75.7,201,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,85.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,90.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,183.86,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,86.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,85.1,448,,facility
PROS SOCK SINGLE PLY BK,L8470,HCPCS,274,RC,,,,outpatient,,,15,1.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,66,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,61,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,9.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,20.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,9.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,10,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,9.8,20.48,,facility
X-RAY EXAM OF ANKLE,73610,CPT,320,RC,,,,outpatient,,,1543,154.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,85.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,174.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,22.64,22.64,23.58,88,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,84.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,83.29,448,,facility
HEP B SURFACE AG NEUTRLZJ IA,87341,CPT,306,RC,,,,outpatient,,,103,10.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,21.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.31,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,10.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,10.33,448,,facility
NUCLEAR ANTIGEN ANTIBODY,86235,CPT,302,RC,,,,outpatient,,,290,29,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13,12.5,15.95,11,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,54.91,4.37,90.29,43,percent of total billed charges,,,33.6,,4.37,4.37,53.09,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,22.18,4.24,83.33,13,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,37.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.95,13,15.95,54,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.75,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.93,448,,facility
INDWELLING CATHETER; FOLEY TYPE; TWO-WAY LATEX WITH COATING (TEFLON; SILICONE; SILICONE ELASTOMER; OR HYDROPHILIC; ETC.); EACH,A4338,HCPCS,0272,RC,,,,outpatient,,,25,2.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",448,448,,facility
CT SCAN OF HEART WITH EVALUATION OF BLOOD VESSEL CALCIUM,75571,CPT,0350,RC,,,,outpatient,,,753,75.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,403,,,,,,,case rate,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,371,,,,,,,case rate,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,875,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1050,,,,,,,case rate,NTE Percentage + Reimbursement Rate 85.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,85.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,397.58,397.58,397.58,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,174.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1522,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,84.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,83.29,1522,,facility
SMEAR GRAM STAIN,87205,CPT,306,RC,,,,outpatient,,,43,4.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.8,3.8,3.8,30,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,180.48,3.16,180.48,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,166.38,166.38,166.38,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,94.75,94.75,148.9,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,94.75,94.75,95.6,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,8.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.8,3.8,3.8,139,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.22,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,4.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,4.27,448,,facility
GENETIC TSTG SEVERE INH COND,81443,CPT,310,RC,,,,outpatient,,,7508,750.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2448.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2448.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2522.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2448.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,5117.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2595.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2448.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2595.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4284.98,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,2497.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,5117.49,,facility
X-RAY OF PART OF LOWER JAW; 1-4 VIEWS,70100,CPT,0320,RC,,,,outpatient,,,950,95,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,85.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,174.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,84.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,83.29,448,,facility
ELECTRON MICROSCOPY DX,88348,CPT,310,RC,,,,outpatient,,,3278,327.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,716.75,711.24,771.08,14,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,2202.88,1496.32,2202.88,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,771.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,771.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,794.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,771.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1611.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,817.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,337.34,337.34,341.35,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,771.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,817.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,946.68,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,786.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1611.56,,facility
ELEC STIM OTHER THAN WOUND,G0283,HCPCS,420,RC,,,,outpatient,,,336,33.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,80,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,24.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,422,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.94,448,,facility
IGH VARI REGIONAL MUTATION,81263,CPT,310,RC,,,,outpatient,,,652.7,65.27,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,294.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,294.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,303.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,294.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,615.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,312.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,294.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,312.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,636.3,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,300.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,294.52,636.3,,facility
CCP ANTIBODY,86200,CPT,302,RC,,,,outpatient,,,45,4.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.52,11.52,11.52,14,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,70.8,70.8,70.8,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,63.36,25.87,63.36,1 through 10,percent of total billed charges,,,33.6,,40.32,40.32,63.36,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,33.26,16.46,40.68,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.52,11.52,11.52,56,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.97,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.95,448,,facility
TREPONEMA PALLIDUM,86780,CPT,302,RC,,,,outpatient,,,213,21.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.78,11.78,11.78,612,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,10.62,10.62,50.15,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,9.5,6.05,48.53,46,percent of total billed charges,,,33.6,,6.05,6.05,44.88,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,6.05,6.05,28.56,66,percent of total billed charges,,,34.6,,73.69,20.19,77.34,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,9,9,42.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,17.85,17.85,17.85,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,11.78,11.78,11.78,1 through 10,percent of total billed charges,,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.78,11.78,11.78,550,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.6,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.24,448,,facility
DETECT AGENT NOS DNA AMP,87798,CPT,306,RC,,,,outpatient,,,239,23.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,110.88,110.88,174.24,1 through 10,percent of total billed charges,,,33.6,,244.27,244.27,244.27,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,96.77,32.38,119.79,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,38.9,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
DETECTION TEST BY IMMUNOASSAY TECHNIQUE FOR STREPTOCOCCUS; GROUP A (STREP),87430,CPT,0306,RC,,,,outpatient,,,75,7.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,14.95,14.95,14.95,49,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,62.72,62.72,62.72,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,12.98,12.98,12.98,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,51.74,32.93,55.96,13,percent of total billed charges,,,33.6,,32.93,32.93,51.74,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,32.93,25.43,32.93,15,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,35.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,20.58,20.58,20.58,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,14.95,14.95,14.95,106,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.42,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,16.81,448,,facility
ENERGY STORING FOOT,L5976,HCPCS,274,RC,,,,outpatient,,,1094,109.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,66,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,61,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,743.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,743.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,765.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,743.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1553.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,787.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,743.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,787.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,758,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,743.14,1553.16,,facility
INITIAL NEW PATIENT PREVENTIVE MEDICINE EVALUATION (18-39 YEARS),99385,CPT,0770,RC,,,,outpatient,,,594,59.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,81.59,81.59,81.59,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
INSERTION OF TUBE AND INTRODUCTION OF CONTRAST FOR X-RAY OF UTERUS AND FALLOPIAN TUBES,58340,CPT,0761,RC,,,,outpatient,,,675,67.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,49.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,49.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,50.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,49.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,102.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,49.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,50.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,49.06,1173,,facility
SOCKET INSERT W LOCK MECH,L5673,HCPCS,274,RC,,,,outpatient,,,1332,133.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,66,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,61,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,896.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,896.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,923.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,896.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1874.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,950.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,896.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,950.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,914.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,896.9,1874.52,,facility
STOOL FAT OR LIPIDS ANALYSIS; QUALITATIVE,82705,CPT,0301,RC,,,,outpatient,,,231,23.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,10.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.54,4.54,4.54,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.01,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.1,448,,facility
MURAMIDASE,85549,CPT,305,RC,,,,outpatient,,,237,23.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.68,16.68,16.68,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,35.38,35.38,35.38,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,39.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.68,16.68,16.68,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,40.51,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.75,448,,facility
OTHER PROCEDURE ON SMALL BOWEL,44799,CPT,0750,RC,,,,outpatient,,,3715,371.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,868.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,868.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,894.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,868.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1814.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,920.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,868.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,920.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3821,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,885.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3821,,facility
INCISION AND DRAINAGE OF ABSCESS OF FEMALE GENITAL GLAND,56420,CPT,0450,RC,,,,outpatient,,,529,52.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,176.51,176.51,176.51,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,193.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,193.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,199.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,347.17,347.17,347.17,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,193.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,404.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,205.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,179.14,179.14,179.14,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,193.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,205.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,197.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,193.49,1173,,facility
ASSAY OF ETHYLENE GLYCOL,82693,CPT,301,RC,,,,outpatient,,,381,38.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,31.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.25,13.25,13.25,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.2,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,15.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.9,448,,facility
ASSAY OF TRIGLYCERIDES,84478,CPT,301,RC,,,,outpatient,,,244,24.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.11,5.11,5.11,49,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,21.12,13.44,142.03,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,13.44,13.44,13.56,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.11,5.11,5.11,55,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.41,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.74,448,,facility
PROTOZOA ANTIBODY NOS,86753,CPT,302,RC,,,,outpatient,,,249,24.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.02,11.02,11.02,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,98.11,98.11,154.18,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,96.77,32.38,106,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.02,11.02,11.02,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.76,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.39,448,,facility
DETECT AGENT NOS DNA AMP,87798,CPT,306,RC,,,,outpatient,,,190,19,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,110.88,110.88,174.24,1 through 10,percent of total billed charges,,,33.6,,244.27,244.27,244.27,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,96.77,32.38,119.79,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,38.9,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
TD VACC NO PRESV 7 YRS+ IM,90714,CPT,636,RC,,,,outpatient,,,86,8.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,52.8,,109.51,57.03,109.63,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,56.53,56.53,56.53,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",448,448,,facility
DRUG TEST PRSMV CHEM ANLYZR,80307,CPT,301,RC,,,,outpatient,,,162,16.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,55.27,55.27,55.27,34,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,62.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,62.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,171.87,131.38,223.26,14,percent of total billed charges,,,33.6,,206.45,131.38,223.26,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,131.38,102.04,131.38,13,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,62.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,129.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,65.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,55.27,55.27,55.27,332,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,62.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,65.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,125.7,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,63.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,62.14,448,,facility
"INJECTION, BORTEZOMIB, 0.1MG",J9041,HCPCS,636,RC,,,,outpatient,,,205,20.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,52.8,,3788.4,3463.68,3788.4,1345,percent of total billed charges,,,33.6,,3788.4,3788.4,3788.4,35,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,241.92,241.92,241.92,456,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",448,448,,facility
REPAIR OF WOUND BY TRANSFERRING SKIN; EACH ADDITIONAL 30.0 SQ CM,14302,CPT,0761,RC,,,,outpatient,,,783,78.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,173.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,173.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,178.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,173.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,362.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,184.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,173.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,184.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,177.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,173.6,1173,,facility
LACTATE (LD) (LDH) ENZYME,83615,CPT,301,RC,,,,outpatient,,,21,2.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.37,5.37,5.37,60,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,38.94,38.94,38.94,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,34.85,11.09,34.85,38,percent of total billed charges,,,33.6,,22.18,22.18,22.18,46,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,20.95,20.95,22.18,22,percent of total billed charges,,,34.6,,23.96,20.95,25.15,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,12.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,13.86,13.86,13.86,17,percent of total billed charges,,,35,,27.5,27.5,27.5,1 through 10,percent of total billed charges,,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.37,5.37,5.37,235,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.04,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,6.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,6.04,448,,facility
DETECT AGENT NOS DNA AMP,87798,CPT,306,RC,,,,outpatient,,,360,36,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,110.88,110.88,174.24,1 through 10,percent of total billed charges,,,33.6,,244.27,244.27,244.27,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,96.77,32.38,119.79,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,38.9,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
DETECT AGENT NOS DNA AMP,87798,CPT,306,RC,,,,outpatient,,,693,69.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,110.88,110.88,174.24,1 through 10,percent of total billed charges,,,33.6,,244.27,244.27,244.27,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,96.77,32.38,119.79,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,38.9,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
RSV VACC PREF BIVALENT IM,90678,CPT,636,RC,,,,outpatient,,,1062,106.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
MICROSOMAL ANTIBODY EACH,86376,CPT,302,RC,,,,outpatient,,,244,24.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.94,12.94,12.94,22,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,22.18,14.11,82.9,1 through 10,percent of total billed charges,,,33.6,,22.51,22.51,22.51,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,22.51,11.27,81.98,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,30.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.94,12.94,12.94,63,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,31.43,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.55,448,,facility
RBC PRETX INCUBATJ W/CHEMICL,86970,CPT,302,RC,,,,outpatient,,,305,30.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,56.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,56.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,58.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,145.56,145.56,145.56,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,56.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,118,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,59.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,56.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,59.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,55.65,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,57.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,55.65,448,,facility
ASSAY OF AMYLASE,82150,CPT,301,RC,,,,outpatient,,,22,2.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.76,5.76,5.76,19,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,95,95,95,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,54.24,31.92,54.25,46,percent of total billed charges,,,33.6,,31.92,27.12,54.24,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,31.92,27.12,31.92,11,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,13.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,40,40,47.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.76,5.76,5.76,306,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,6.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,6.48,448,,facility
REMOVAL OF FOREIGN BODY IN EAR CANAL,69200,CPT,0450,RC,,,,outpatient,,,725,72.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,131.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,266.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,134.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,134.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,129.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,127.33,448,,facility
UNLISTED MOLECULAR PATHOLOGY,81479,CPT,310,RC,,,,outpatient,,,125,12.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,561.56,561.56,561.56,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,32.5,32.5,3071.5,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
ANALYSIS FOR ANTIBODY TO HIV-2 VIRUS,86702,CPT,0302,RC,,,,outpatient,,,90,9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,66.56,66.56,165.12,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,72.57,72.57,72.57,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,34.94,34.94,54.91,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,34.29,34.29,37.75,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,28.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.21,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.52,448,,facility
REPAIR OF VERTICAL LIP WOUND EXTENDING TO HALF OF LIP,40652,CPT,0450,RC,,,,outpatient,,,3201,320.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1027,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1519,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,516.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,516.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,531.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,516.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1078.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,547.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,516.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,547.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,526.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1519,,facility
DETECT AGNT MULT DNA AMPLI,87801,CPT,306,RC,,,,outpatient,,,1731,173.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,70.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,70.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,72.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,70.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,146.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,74.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,62.44,62.44,62.44,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,70.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,74.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,151.66,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,71.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,70.2,448,,facility
EVALUATION FOR OCCUPATIONAL THERAPY; TYPICALLY 45 MINUTES,97166,CPT,0434,RC,,,,outpatient,,,637,63.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,51.96,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,89.84,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,80,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,95.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,95.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,98.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,95.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,199.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,95.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,422,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,97.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,51.96,448,,facility
RESPIRATORY INFECTIOUS AGENT DETECTION BY RNA FOR SEVERE ACUTE RESPIRATORY SYNDROME CORONAVIRUS 2 (COVID-19); INFLUENZA A; AND INFLUENZA B) IN UPPER RESPIRATORY SPECIMEN; EACH REPORTED AS DETECTED OR NOT DETECTED,0240U,CPT,0300,RC,,,,outpatient,,,152,15.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,142.63,142.63,142.63,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 103.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment.",,,,0,other,"Payer contract is 103.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment. + No services performed during 15-month lookback period",,52.8,,51.53,51.53,51.53,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment. + No services performed during 15-month lookback period",,,"Payer contract is 209.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment.",,,,0,other,"Payer contract is 209.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment. + No services performed during 15-month lookback period",,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment. + No services performed during 15-month lookback period",,50,,76,76,76,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment.",142.63,142.63,142.63,1 through 10,other,"Payer contract is 100.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment.",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,249.55,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,"Payer contract is 102.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment.",145.48,145.48,145.48,26,other,"Payer contract is 102.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment.",249.55,448,,facility
BLOOD TYPING SEROLOGIC ABO,86900,CPT,302,RC,,,,outpatient,,,224,22.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,113.1,113.1,127.33,523,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,207.68,21.24,207.68,13,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,131.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,118.27,18.88,200.99,116,percent of total billed charges,,,33.6,,118.27,18.88,118.27,44,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,118.27,12.1,134.11,78,percent of total billed charges,,,34.6,,130.24,127.78,134.11,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,266.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,134.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,176,17.88,176,13,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,73.92,7.56,73.92,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,2.66,2.66,2.66,1 through 10,percent of total billed charges,,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,2.66,2.66,2.66,824,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,134.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.46,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,129.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,6.46,448,,facility
CISPLATIN 10 MG INJECTION,J9060,HCPCS,636,RC,,,,outpatient,,,14,1.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,44.8,44.8,125.44,197,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,52.8,,73.03,73.03,152.45,57,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,32.24,32.24,32.24,12,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,50,,82.99,77.81,82.99,49,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,23.96,23.28,23.96,35,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",448,448,,facility
APP MDLTY 1+ULTRASOUND EA 15,97035,CPT,420,RC,,,,outpatient,,,161,16.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,51.96,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,89.84,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,80,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,28.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,422,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.54,448,,facility
ASSAY ANTI-MULLERIAN HORM,82166,CPT,301,RC,,,,outpatient,,,325,32.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,39.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,98.74,98.74,118.27,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,62.83,62.83,63.39,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,38.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,80.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,40.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,93.5,93.5,93.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,38.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,40.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,67.59,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,39.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,38.62,448,,facility
INTERMEDIATE RADIATION THERAPY PLANNING FOR DELIVERY OF INTERNAL RADIATION,77317,CPT,0333,RC,,,,outpatient,,,1684,168.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,358.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,358.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,369.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,358.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,748.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,379.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,358.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,379.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,48815,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,365.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,358.36,48815,,facility
DETECT AGENT NOS DNA QUANT,87799,CPT,306,RC,,,,outpatient,,,550,55,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,38.11,38.11,38.11,39,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,44.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,200.64,91.44,597.79,1 through 10,percent of total billed charges,,,33.6,,203.95,203.95,203.95,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,231.27,203.95,231.27,11,percent of total billed charges,,,34.6,,220.34,220.34,231.27,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,89.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,45.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,38.11,38.11,38.11,221,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,45.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,92.54,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,43.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,42.84,448,,facility
PALONOSETRON HCL,J2469,HCPCS,636,RC,,,,outpatient,,,18,1.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,115.2,44.6,376.32,840,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,44.6,44.6,44.6,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,52.8,,95.04,25.4,310.46,850,percent of total billed charges,,,33.6,,25.4,12.7,197.57,250,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,197.57,12.7,199.33,460,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,50,,294,37.8,294,50,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,15.88,7.94,15.88,50,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",448,448,,facility
ASSAY OF PARATHORMONE,83970,CPT,301,RC,,,,outpatient,,,150,15,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,36.72,36.72,36.72,87,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,67.85,67.85,67.85,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,41.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,41.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,60.72,38.64,209.62,23,percent of total billed charges,,,33.6,,38.64,38.64,38.64,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,38.99,38.64,134.58,39,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,41.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,86.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,43.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,83.37,83.37,83.37,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,36.72,36.72,36.72,244,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,41.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,43.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,89.18,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,42.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,41.28,448,,facility
BELOW KNEE SUCTION SOCKET,L5647,HCPCS,274,RC,,,,outpatient,,,1445,144.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,66,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,61,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,973.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,973.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1003.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,973.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,2035.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1032.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,973.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1032.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,993.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,973.84,2035.33,,facility
MRI SCAN OF UPPER SPINAL CANAL WITHOUT CONTRAST,72141,CPT,0612,RC,,,,outpatient,,,8004,800.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,212.09,212.09,212.09,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,786,,,,,,,case rate,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,728,,,,,,,case rate,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,5842.92,98.99,5842.92,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1025,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1350,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,235.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,4226.11,4226.11,4226.11,1 through 10,percent of total billed charges,,,33.6,,4570.28,4570.28,4570.28,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,2689.34,2689.34,2713.36,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,477.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,242.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,4002,4002,4002,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,105.48,105.48,105.48,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,242.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2407,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,232.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,228.36,2407,,facility
ASSAY NONENDOCRINE RECEPTOR,84238,CPT,301,RC,,,,outpatient,,,308,30.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,37.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,36.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,76.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,38.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,36.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,38.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,79,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,37.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,36.57,448,,facility
REMOVAL OF FOREIGN BODY FROM TISSUE; ACCESSED BENEATH THE SKIN; SIMPLE,10120,CPT,0450,RC,,,,outpatient,,,1232,123.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,350.55,350.55,358.86,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,400.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,813.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,412.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,355.79,355.79,366.07,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,412.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,396.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,389.05,1173,,facility
CHOLESTEROL LEVEL,82465,CPT,0301,RC,,,,outpatient,,,62,6.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.87,3.87,3.87,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,20.83,20.83,20.83,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,9.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.87,3.87,3.87,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.4,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,4.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,4.35,448,,facility
N.GONORRHOEAE DNA AMP PROB,87591,CPT,306,RC,,,,outpatient,,,1597,159.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,442,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,50.15,20.65,65.49,11,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,228.48,228.48,228.48,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,37.3,18.48,58.61,60,percent of total billed charges,,,33.6,,37.3,11.76,63.38,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,28.82,11.76,37.3,69,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,42.5,17.5,55.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,23.31,23.31,23.31,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,31.21,31.21,31.21,1 through 10,percent of total billed charges,,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,796,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
QUANTITATIVE ASSAY DRUG,80299,CPT,301,RC,,,,outpatient,,,156,15.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,13,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,174.64,174.64,174.64,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,171.6,171.6,171.6,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,374.52,374.52,374.52,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.62,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.64,448,,facility
ISLET CELL ANTIBODY,86341,CPT,302,RC,,,,outpatient,,,359,35.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,20.97,20.97,20.97,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,23.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,23.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,143.62,143.62,326.83,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,258.38,258.38,258.38,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,23.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,49.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,24.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,20.97,20.97,20.97,14,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,23.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,24.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.75,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,24.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,23.57,448,,facility
MOPATH PROCEDURE LEVEL 7,81406,CPT,310,RC,,,,outpatient,,,3430,343,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,282.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,282.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,291.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,282.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,591.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,299.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,282.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,299.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,495.04,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,288.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,282.88,591.22,,facility
RSV MONOC ANTB SEASN .5ML IM,90380,CPT,636,RC,,,,outpatient,,,555,55.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
X-RAY OF WRIST; 2 VIEWS,73100,CPT,0320,RC,,,,outpatient,,,757,75.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,85.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,174.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,20.75,20.75,21.64,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,84.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,83.29,448,,facility
ASSAY FOR CALPROTECTIN FECAL,83993,CPT,301,RC,,,,outpatient,,,1089,108.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,17.46,17.46,17.46,30,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,158.4,100.8,168.43,1 through 10,percent of total billed charges,,,33.6,,168.43,100.8,225.98,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,107.18,107.18,107.18,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,41.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,20.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,159.5,159.5,159.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,17.46,17.46,17.46,68,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,20.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.42,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,20.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,19.63,448,,facility
EXOSKELETAL AK ULTRA-LIGHT M,L5790,HCPCS,274,RC,,,,outpatient,,,1727,172.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,66,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,61,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1173.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1173.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1208.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1173.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,2452.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1244.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1173.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1244.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,1197.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,1173.68,2452.99,,facility
CT SCAN OF LEG WITHOUT CONTRAST,73700,CPT,0350,RC,,,,outpatient,,,4603,460.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,403,,,,,,,case rate,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,371,,,,,,,case rate,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,875,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1050,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,68.79,68.79,71.62,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1522,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,1522,,facility
FUROSEMIDE INJECTION,J1940,HCPCS,636,RC,,,,outpatient,,,66,6.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 103.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment.",,,,0,other,"Payer contract is 103.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment. + No services performed during 15-month lookback period",,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment. + No services performed during 15-month lookback period",,,"Payer contract is 209.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment.",,,,0,other,"Payer contract is 209.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment. + No services performed during 15-month lookback period",,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment. + No services performed during 15-month lookback period",,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 102.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment.",,,,0,other,"Payer contract is 102.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment. + No services performed during 15-month lookback period",448,448,,facility
REPAIR OF WOUND BY TRANSFERRING SKIN; 30.1-60.0 SQ CM,14301,CPT,0761,RC,,,,outpatient,,,3143,314.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1027,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1519,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3391.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3391.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3493.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3391.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,7088.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3595.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3143,3143,3143,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3391.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3595.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,3459.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,7088.34,,facility
AK/KNEE DISARTIC SILESIAN BA,L5698,HCPCS,274,RC,,,,outpatient,,,217,21.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,66,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,61,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,146.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,146.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,150.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,146.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,306.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,155.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,146.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,155.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,149.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,146.51,306.21,,facility
HLA II TYPE 1 AG EQUIV LR,81377,CPT,310,RC,,,,outpatient,,,626,62.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,94.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,94.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,97.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,94.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,198.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,94.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,198.36,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,96.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,94.74,448,,facility
WHFO W/O JOINTS PRE OTS,L3809,HCPCS,274,RC,,,,outpatient,,,459,45.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,66,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,61,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,281.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,281.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,289.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,281.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,587.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,298.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,281.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,298.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,286.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,281.17,587.65,,facility
"INJECTION, CARFILZOMIB, 1 MG",J9047,HCPCS,636,RC,,,,outpatient,,,182,18.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,60.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,60.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,62.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,60.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,126.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,63.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,60.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,63.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,111.74,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,61.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,60.29,448,,facility
GENE ANALYSIS (ISOCITRATE DEHYDROGENASE 2 [NADP+]; MITOCHONDRIAL) FOR COMMON VARIANTS,81121,CPT,0310,RC,,,,outpatient,,,405,40.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,295.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,295.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,304.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,137.3,137.3,137.3,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,295.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,618.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,313.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,295.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,313.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,517.63,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,301.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,295.79,618.2,,facility
SYPHILIS TEST NON-TREP QUAL,86592,CPT,302,RC,,,,outpatient,,,99,9.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.8,3.8,3.8,262,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,28.8,3.16,28.8,20,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,26.55,26.4,79.65,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,28.8,28.8,28.8,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,23.76,15.12,23.76,39,percent of total billed charges,,,33.6,,15.17,15.12,45.36,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,15.12,15.12,15.17,34,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,8.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,22.38,22.38,22.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.8,3.8,3.8,282,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.22,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,4.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,4.27,448,,facility
B CELLS TOTAL COUNT,86355,CPT,302,RC,,,,outpatient,,,317,31.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,33.56,33.56,33.56,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,60.77,60.77,60.77,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,37.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,37.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,27.98,27.98,27.98,1 through 10,percent of total billed charges,,,33.6,,33.56,33.56,33.56,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,63.63,63.63,63.63,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,78.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,39.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,33.56,33.56,33.56,25,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,39.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,81.52,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,38.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,37.73,448,,facility
DRUG SCREEN AMPHETAMINES 1/2,80324,CPT,301,RC,,,,outpatient,,,182,18.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
QUANTITATIVE ASSAY DRUG,80299,CPT,301,RC,,,,outpatient,,,324,32.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,13,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,174.64,174.64,174.64,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,171.6,171.6,171.6,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,374.52,374.52,374.52,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.62,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.64,448,,facility
DOXORUBICIN HCL INJECTION,J9000,HCPCS,636,RC,,,,outpatient,,,436,43.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,164.45,8.65,273.49,149,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,52.8,,45.42,37.75,2762.5,109,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,53.29,53.29,1921.45,25,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",448,448,,facility
IMMUNOASSAY QUANT NOS NONAB,83520,CPT,301,RC,,,,outpatient,,,725,72.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,36,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,66.08,66.08,66.08,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,41.18,24.82,318.38,1 through 10,percent of total billed charges,,,33.6,,37.63,37.63,96.43,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,33.6,23.18,176.4,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,36.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,87,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.22,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.27,448,,facility
MOPATH PROCEDURE LEVEL 2,81401,CPT,310,RC,,,,outpatient,,,1682,168.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,121.86,121.86,121.86,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,137,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,137,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,141.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,137,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,286.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,145.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,137,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,145.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,239.75,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,139.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,137,448,,facility
MEASUREMENT OF DNA OF BACTERIA IN VAGINAL FLUID SPECIMEN,81514,CPT,0300,RC,,,,outpatient,,,306,30.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,76.5,76.5,76.5,38,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,225.28,195.84,225.28,22,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,207.68,207.68,207.68,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,262.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,262.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,270.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,185.86,118.27,185.86,27,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,118.27,103.73,118.27,27,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,262.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,549.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,278.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,176,176,176,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,73.92,73.92,73.92,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,262.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,278.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,460.23,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,268.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,262.99,549.65,,facility
NERVE CONDUCTION; 11-12 STUDIES,95912,CPT,0922,RC,,,,outpatient,,,1818,181.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,357.13,329.42,504.72,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,357.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,357.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,367.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,357.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,746.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,378.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,71.19,71.19,77.43,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,357.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,378.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,478,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,364.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,357.13,746.4,,facility
QUANTITATIVE ASSAY DRUG,80299,CPT,301,RC,,,,outpatient,,,571,57.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,13,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,174.64,174.64,174.64,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,171.6,171.6,171.6,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,374.52,374.52,374.52,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.62,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.64,448,,facility
BRAF GENE,81210,CPT,310,RC,,,,outpatient,,,681,68.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,156.02,156.02,156.02,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,175.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,175.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,180.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,175.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,366.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,185.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,156.02,156.02,156.02,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,175.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,185.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,306.95,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,178.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,175.4,448,,facility
CLOSED TREATMENT OF BROKEN FINGER OR THUMB AT MIDPORTION OR PART NEAR HAND WITH MANIPULATION,26725,CPT,0450,RC,,,,outpatient,,,2910,291,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,243.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,493.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,213.62,213.62,222.13,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,240.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,236.08,1311,,facility
MRI SCAN OF BONE OF EYE SOCKET; FACE; AND/OR NECK WITHOUT CONTRAST,70540,CPT,0611,RC,,,,outpatient,,,7235,723.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,786,,,,,,,case rate,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,728,,,,,,,case rate,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1025,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1350,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,235.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,477.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,242.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,3617.5,3617.5,3617.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,242.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2407,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,232.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,228.36,2407,,facility
USE OF A DRUG TO INDUCE DEPRESSION OF CONSCIOUSNESS BY PHYSICIAN PERFORMING A PROCEDURE (5 YEARS OR OLDER); INITIAL 15 MINUTES,99152,CPT,0370,RC,,,,outpatient,,,831,83.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,531.84,531.84,531.84,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,52.8,,373.12,316.61,373.12,15,percent of total billed charges,,,33.6,,279.22,279.22,342.05,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,279.22,279.22,281.71,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,50,,415.5,415.5,415.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,216.39,106.19,490.25,45,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",448,448,,facility
DETECT AGENT NOS DNA AMP,87798,CPT,306,RC,,,,outpatient,,,802,80.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,110.88,110.88,174.24,1 through 10,percent of total billed charges,,,33.6,,244.27,244.27,244.27,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,96.77,32.38,119.79,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,38.9,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
CHLMYD TRACH DNA AMP PROBE,87491,CPT,306,RC,,,,outpatient,,,55,5.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,442,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,20.65,20.65,65.49,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,232.32,232.32,232.32,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,37.3,18.48,58.61,62,percent of total billed charges,,,33.6,,37.3,11.76,63.38,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,28.82,11.76,37.3,69,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,42.5,17.5,55.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,23.31,23.31,23.31,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,31.21,31.21,31.21,1 through 10,percent of total billed charges,,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,796,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
IMMUNOASSAY QUANT NOS NONAB,83520,CPT,301,RC,,,,outpatient,,,1200,120,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,36,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,66.08,66.08,66.08,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,41.18,24.82,318.38,1 through 10,percent of total billed charges,,,33.6,,37.63,37.63,96.43,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,33.6,23.18,176.4,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,36.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,87,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.22,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.27,448,,facility
DRAINAGE OF HEART SAC USING IMAGING GUIDANCE,33016,CPT,0481,RC,,,,outpatient,,,5765,576.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,1506.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1506.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1551.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1506.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3148.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1596.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1506.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1596.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2712,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1536.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3148.69,,facility
PTEN GENE DUP/DELET VARIANT,81323,CPT,310,RC,,,,outpatient,,,317,31.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,300,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,300,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,309,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,300,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,627,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,318,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,300,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,318,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,525,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,306,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,300,627,,facility
MOLECULAR PATHOLOGY PROCEDURE,81479,CPT,0310,RC,,,,outpatient,,,6143,614.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,561.56,561.56,561.56,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,32.5,32.5,3071.5,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
INJ RETACRIT NON-ESRD USE,Q5106,HCPCS,636,RC,,,,outpatient,,,46,4.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,7.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,7.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,16.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,7.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.06,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,8.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,7.97,448,,facility
UNLISTED MOLECULAR PATHOLOGY,81479,CPT,310,RC,,,,outpatient,,,4385,438.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,561.56,561.56,561.56,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,32.5,32.5,3071.5,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
DELIVERY OF COMPLEX HIGH PRECISION RADIATION TREATMENT,77386,CPT,0333,RC,,,,outpatient,,,4079,407.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,507.55,507.55,515.14,118,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,2610.56,2610.56,2610.56,12,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 103.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment.",,,,0,other,"Payer contract is 103.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment. + No services performed during 15-month lookback period",,52.8,,1370.54,1370.54,2153.71,61,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,1370.54,1370.54,1370.54,19,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment. + No services performed during 15-month lookback period",,,"Payer contract is 209.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment.",,,,0,other,"Payer contract is 209.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment. + No services performed during 15-month lookback period",,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment. + No services performed during 15-month lookback period",,50,,2039.5,2039.5,2039.5,18,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,515.14,515.14,515.14,127,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment.",550.25,550.25,1100.5,139,other,"Payer contract is 100.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment.",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,48815,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,"Payer contract is 102.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment.",561.26,561.26,561.26,552,other,"Payer contract is 102.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment.",448,48815,,facility
BRAF GENE,81210,CPT,310,RC,,,,outpatient,,,1035,103.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,156.02,156.02,156.02,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,175.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,175.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,180.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,175.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,366.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,185.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,156.02,156.02,156.02,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,175.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,185.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,306.95,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,178.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,175.4,448,,facility
HISTOPLASMA ANTIBODY,86698,CPT,302,RC,,,,outpatient,,,191,19.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.27,12.27,12.27,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,28.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.27,12.27,12.27,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.79,448,,facility
PREPARATION OF STEM CELLS FOR TRANSPLANTATION WITH REDUCTION OF BLOOD FLUID (PLASMA) VOLUME,38214,CPT,0310,RC,,,,outpatient,,,1697,169.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,422.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,422.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,434.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,655.87,655.87,655.87,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,646.56,646.56,646.56,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,422.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,882.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,447.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,422.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,447.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,430.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,422.23,882.46,,facility
MANUAL THERAPY 1/> REGIONS,97140,CPT,420,RC,,,,outpatient,,,275,27.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,51.96,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,89.84,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,80,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,26.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,54.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,27.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,26.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,27.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,422,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,26.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,26.26,448,,facility
OBINUTUZUMAB INJ,J9301,HCPCS,636,RC,,,,outpatient,,,278,27.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,84.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,84.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,86.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,84.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,176.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,89.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,84.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,89.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,160.88,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,86.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,84.46,448,,facility
COMPLICATED REPAIR OF WOUND OF FOREHEAD; CHEEKS; CHIN; MOUTH; NECK; UNDERARMS; GENITALS; HANDS; OR FEET; 1.1-2.5 CM,13131,CPT,0456,RC,,,,outpatient,,,3201,320.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,400.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,813.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,412.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,412.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,405,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,396.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,389.05,1311,,facility
ASSAY IGA/IGD/IGG/IGM EACH,82784,CPT,301,RC,,,,outpatient,,,124,12.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,8.27,8.27,8.27,98,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,114.46,59,343.38,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,52.8,30.49,158.4,64,percent of total billed charges,,,33.6,,19.58,19.49,33.6,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,53.09,19.49,195.55,67,percent of total billed charges,,,34.6,,190.57,73.91,336.04,67,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,9.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,19.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,9.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,29,29,50,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,8.27,8.27,8.27,371,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,9.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,9.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.09,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,9.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,9.3,448,,facility
ENZYME CELL ACTIVITY,82657,CPT,301,RC,,,,outpatient,,,223,22.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.72,19.72,19.72,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,2094.14,2094.14,2094.14,1 through 10,percent of total billed charges,,,33.6,,762.96,762.96,762.96,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,46.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,23.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.72,19.72,19.72,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,23.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,39.01,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,22.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,22.17,448,,facility
AZACITIDINE INJECTION,J9025,HCPCS,636,RC,,,,outpatient,,,5,0.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,240.66,240.66,240.66,191,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,52.8,,336,168,336,6900,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,59.59,59.59,59.59,465,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",448,448,,facility
IMMUNOASSAY NONANTIBODY,83516,CPT,301,RC,,,,outpatient,,,455,45.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9,9,10.26,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,4.75,4.75,218.59,30,percent of total billed charges,,,33.6,,3.02,3.02,175.39,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,3.02,3.02,211.68,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,24.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,23.5,23.5,23.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9,9,10.26,51,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.92,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,11.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.53,448,,facility
ULTRASOUND MEASUREMENT OF BLADDER CAPACITY AFTER VOIDING,51798,CPT,0450,RC,,,,outpatient,,,776,77.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,56.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,56.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,58.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,287.95,287.95,287.95,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,56.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,118,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,59.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,56.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,59.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,57.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,56.46,448,,facility
"IMMUNE GLOBULIN, POWDER",J1566,HCPCS,636,RC,,,,outpatient,,,471,47.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,80.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,80.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,80.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,169.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,85.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,80.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,85.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,175.07,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,82.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,80.96,448,,facility
VASOACTIVE INTESTINAL PEPTIDE (INTESTINAL HORMONE) LEVEL,84586,CPT,0301,RC,,,,outpatient,,,363,36.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,191.66,191.66,191.66,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,76.34,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,36.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.33,448,,facility
FUNGAL CULTURE (MOLD OR YEAST),87102,CPT,0306,RC,,,,outpatient,,,616,61.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,7.48,7.48,7.48,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,206.98,206.98,325.25,1 through 10,percent of total billed charges,,,33.6,,206.98,206.98,206.98,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,206.98,206.98,206.98,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,17.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,7.48,7.48,7.48,47,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.17,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,8.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,8.41,448,,facility
HLA CLASS I AND II TYPING HIGH RESOLUTION HLA-A; -B; -C; AND -DRB1,81378,CPT,0300,RC,,,,outpatient,,,1852,185.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,307.38,307.38,307.38,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,345.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,345.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,355.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,345.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,722.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,366.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,345.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,366.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,746.6,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,352.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,345.57,746.6,,facility
LACTIC ACID LEVEL,83605,CPT,0301,RC,,,,outpatient,,,1117,111.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.29,10.29,10.29,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,129.62,76.27,637.81,57,percent of total billed charges,,,33.6,,275.32,76.27,451.58,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,375.31,76.27,375.31,34,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,24.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,558.5,113.5,1117,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.29,10.29,10.29,439,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,23.08,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,11.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.57,448,,facility
REPAIR OF WOUND OF EYELIDS; NOSE; EARS; OR LIPS BY TRANSFERRING SKIN; 10.0 SQ CM OR LESS,14060,CPT,0761,RC,,,,outpatient,,,3143,314.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1027,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1519,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1974.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1974.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2033.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1974.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,4127.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2093.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,814.48,814.48,814.48,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1974.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2093.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,2014.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,4127.08,,facility
AMPHETAMINES 5 OR MORE,80326,CPT,301,RC,,,,outpatient,,,431,43.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
ANTIBODY IDENTIFICATION TEST FOR WHITE BLOOD CELL ANTIBODIES,86021,CPT,0302,RC,,,,outpatient,,,38.75,3.88,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.39,13.39,13.39,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,20.59,13.1,38.54,1 through 10,percent of total billed charges,,,33.6,,134.11,134.11,134.11,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,13.1,13.1,13.1,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,31.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.39,13.39,13.39,23,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.53,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,15.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,15.05,448,,facility
PROTEIN C ANTIGEN (CLOTTING INHIBITOR) MEASUREMENT,85303,CPT,0305,RC,,,,outpatient,,,77,7.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.31,12.31,12.31,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,40.66,25.87,40.66,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,28.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.31,12.31,12.31,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.89,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.84,448,,facility
ASSAY OF VOLATILES,84600,CPT,301,RC,,,,outpatient,,,164,16.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,35.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,34.74,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.11,448,,facility
COL CHROMOTOGRAPHY QUAL/QUAN,82542,CPT,301,RC,,,,outpatient,,,88,8.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,21.43,21.43,21.43,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,435.07,435.07,435.07,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,24.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,50.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,25.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,21.43,21.43,21.43,15,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,24.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,25.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.16,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,24.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,24.09,448,,facility
ACTIN ANTIBODY EACH,86015,CPT,302,RC,,,,outpatient,,,221,22.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.72,10.72,10.72,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,12.1,12.1,31.68,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,20.16,20.16,20.16,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.72,10.72,10.72,43,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.18,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.05,448,,facility
CT SCAN OF BLOOD VESSELS AND GRAFTS OF HEART WITH CONTRAST,75574,CPT,0350,RC,,,,outpatient,,,593,59.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,411,411,411,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,875,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1050,,,,,,,case rate,NTE Percentage + Reimbursement Rate 85.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,333.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,333.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,343.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,313.1,259.06,407.09,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,259.06,259.06,259.06,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,333.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,697.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,353.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,333.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,353.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1522,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,340.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,333.9,1522,,facility
VAGINAL ULTRASOUND OF PREGNANT UTERUS,76817,CPT,0402,RC,,,,outpatient,,,1821,182.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,611.86,611.86,611.86,1 through 10,percent of total billed charges,,,33.6,,611.86,611.86,611.86,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,611.86,611.86,611.86,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,382.41,382.41,382.41,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,45.58,45.58,47.74,37,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,465,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,465,,facility
COMPLEMENT ANTIGEN,86160,CPT,302,RC,,,,outpatient,,,166,16.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.67,10.67,10.67,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,87.32,87.32,87.32,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,78.14,49.73,270.86,17,percent of total billed charges,,,33.6,,49.73,49.73,172.37,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,49.73,29.23,50.32,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,256.5,256.5,256.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.67,10.67,10.67,61,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.92,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12,448,,facility
PROS SOCK SINGLE PLY AK,L8480,HCPCS,274,RC,,,,outpatient,,,20,2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,66,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,61,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,26.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,13.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.87,26.9,,facility
FLUORESCENT ANTIBODY SCREEN,86255,CPT,302,RC,,,,outpatient,,,294,29.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.72,10.72,10.72,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,45.41,28.9,1068.67,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,28.9,28.9,28.9,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.72,10.72,10.72,19,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.04,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.05,448,,facility
QUANTITATIVE ASSAY DRUG,80299,CPT,301,RC,,,,outpatient,,,500,50,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,13,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,174.64,174.64,174.64,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,171.6,171.6,171.6,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,374.52,374.52,374.52,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.62,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.64,448,,facility
CHORIONIC GONADOTROPIN TEST,84702,CPT,301,RC,,,,outpatient,,,9,0.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.39,13.39,13.39,99,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,35.99,35.99,146.32,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,32.21,32.21,141.61,16,percent of total billed charges,,,33.6,,32.21,20.5,83.33,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,20.5,20.5,83.33,45,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,31.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,12.81,12.81,12.81,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,13.39,13.39,13.39,1 through 10,percent of total billed charges,,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.39,13.39,13.39,208,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.53,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,15.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,15.05,448,,facility
ANTINUCLEAR ANTIBODIES,86038,CPT,302,RC,,,,outpatient,,,327,32.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.75,10.75,10.75,34,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,148.09,148.09,148.09,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,84.34,29.04,132.53,14,percent of total billed charges,,,33.6,,84.34,18.48,127.78,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,84.34,84.34,85.09,12,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,11.55,11.55,11.55,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.75,10.75,10.75,126,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.11,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.09,448,,facility
FETAL CHRMOML MICRODELTJ,81422,CPT,310,RC,,,,outpatient,,,1019,101.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,759.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,759.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,781.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,759.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1586.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,804.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,759.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,804.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1328.34,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,774.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1586.41,,facility
MRI SCAN OF BLOOD VESSELS OF HEAD WITHOUT CONTRAST,70544,CPT,0610,RC,,,,outpatient,,,5087,508.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1025,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1350,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,235.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,1709.23,1709.23,1709.23,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,477.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,242.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,242.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2407,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,232.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,228.36,2407,,facility
RUBEOLA ANTIBODY,86765,CPT,302,RC,,,,outpatient,,,272,27.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.46,11.46,11.46,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,22.18,22.18,83.95,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,20.68,20.68,20.68,1 through 10,percent of total billed charges,,,34.6,,61.35,61.35,61.35,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,26.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,44,44,44,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.46,11.46,11.46,18,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.88,448,,facility
CLOSED TREATMENT OF BROKEN MIDPART OF FOREARM BONE ON THUMB SIDE WITH MANIPULATION,25505,CPT,0450,RC,,,,outpatient,,,3201,320.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1585.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3216.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1631.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1631.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1569.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3216.38,,facility
COMPLICATED REPAIR OF WOUND OF FOREHEAD; CHEEKS; CHIN; MOUTH; NECK; UNDERARMS; GENITALS; HANDS; OR FEET; 2.6-7.5 CM,13132,CPT,0450,RC,,,,outpatient,,,2910,291,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1027,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1519,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,400.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,813.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,412.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,545.11,545.11,545.11,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,412.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,396.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,389.05,1519,,facility
HEMOGLOBIN ELECTROPHORESIS,83020,CPT,301,RC,,,,outpatient,,,360,36,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.45,11.45,11.45,22,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,12.1,12.1,12.29,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,26.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,18,18,18,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,29.19,29.19,29.19,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.45,11.45,11.45,47,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.81,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.87,448,,facility
LYME DISEASE ANTIBODY,86618,CPT,302,RC,,,,outpatient,,,356,35.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,35.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.15,15.15,15.15,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.79,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.03,448,,facility
ANTIDEPRESSANTS LEVELS; 1 OR 2 (TRICYCLIC AND OTHER CYCLICALS),80335,CPT,0301,RC,,,,outpatient,,,158,15.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
CLOT FACTOR X STUART-POWER,85260,CPT,305,RC,,,,outpatient,,,508,50.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,37.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.92,0.22,15.92,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.68,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.9,448,,facility
UNLISTED MOLECULAR PATHOLOGY,81479,CPT,310,RC,,,,outpatient,,,380,38,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,561.56,561.56,561.56,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,32.5,32.5,3071.5,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
MRI SCAN OF LOWER SPINAL CANAL WITHOUT CONTRAST,72148,CPT,0612,RC,,,,outpatient,,,8653,865.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,212.09,210.64,228.36,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,786,,,,,,,case rate,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,728,,,,,,,case rate,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,6316.69,198.64,6316.69,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1025,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1350,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,235.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,4568.78,2907.41,4940.87,1 through 10,percent of total billed charges,,,33.6,,2907.41,2907.41,2907.41,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,2907.41,2907.41,2933.37,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,477.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,242.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,4326.5,4326.5,4326.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,100.61,100.61,105.76,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,242.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2407,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,232.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,228.36,2407,,facility
IMFLUOR 1ST 1ANTB STAIN PX,88346,CPT,310,RC,,,,outpatient,,,1321,132.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,150.35,150.35,150.35,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,167.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,340.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,172.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,88.73,88.73,88.73,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,172.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,377,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,166.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,163.06,448,,facility
INJ PEMBROLIZUMAB,J9271,HCPCS,636,RC,,,,outpatient,,,225,22.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,28800,28800,28800,1000,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,60.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,60.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,62.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,23760,23760,23760,4800,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,15255,15255,15255,400,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,60.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,126.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,64.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,60.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,64.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,123.84,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,61.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,60.65,448,,facility
INJ HEPARIN SODIUM PER 10 U,J1642,HCPCS,636,RC,,,,outpatient,,,3,0.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,1.76,1.76,8.32,120,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,2.73,2.73,2.73,150,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",448,448,,facility
INJ POTASSIUM CHLORIDE,J3480,HCPCS,636,RC,,,,outpatient,,,4,0.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,25.6,12.8,25.6,190,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,52.8,,8.45,8.45,8.45,20,percent of total billed charges,,,33.6,,1.85,1.85,11.09,20,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,8.8,8,9.24,70,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,3.36,3.36,3.36,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",448,448,,facility
ANTINUCLEAR ANTIBODIES,86038,CPT,302,RC,,,,outpatient,,,239,23.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.75,10.75,10.75,34,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,148.09,148.09,148.09,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,84.34,29.04,132.53,14,percent of total billed charges,,,33.6,,84.34,18.48,127.78,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,84.34,84.34,85.09,12,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,11.55,11.55,11.55,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.75,10.75,10.75,126,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.11,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.09,448,,facility
UNLISTED MOLECULAR PATHOLOGY,81479,CPT,310,RC,,,,outpatient,,,3224,322.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,561.56,561.56,561.56,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,32.5,32.5,3071.5,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
DETECTION TEST BY NUCLEIC ACID FOR MULTIPLE ORGANISMS; AMPLIFIED PROBE(S) TECHNIQUE,87801,CPT,0306,RC,,,,outpatient,,,2277,227.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,70.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,70.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,72.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,70.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,146.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,74.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,62.44,62.44,62.44,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,70.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,74.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,151.66,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,71.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,70.2,448,,facility
IGG 1 2 3 OR 4 EACH,82787,CPT,301,RC,,,,outpatient,,,90,9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,52.8,13.2,263.18,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,33.9,33.9,33.9,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,16.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.33,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,8.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,8.02,448,,facility
MLH1 GENE FULL SEQ,81292,CPT,310,RC,,,,outpatient,,,683,68.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,675.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,675.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,695.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,675.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1411.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,715.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,675.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,715.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1181.95,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,688.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1411.59,,facility
BODY FLUID CELL COUNT,89051,CPT,309,RC,,,,outpatient,,,463,46.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,503.78,376.99,592.42,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,11.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.98,4.98,4.98,47,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.9,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.6,448,,facility
CHIMERISM ANAL NO CELL SELEC,81267,CPT,310,RC,,,,outpatient,,,438,43.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,184.53,184.53,184.53,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,207.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,207.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,213.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,1059.7,1059.7,1059.7,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,207.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,433.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,219.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,184.53,184.53,391.84,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,207.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,219.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,448.21,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,211.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,207.46,448.21,,facility
ISLET CELL ANTIBODY,86341,CPT,302,RC,,,,outpatient,,,266,26.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,20.97,20.97,20.97,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,23.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,23.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,143.62,143.62,326.83,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,258.38,258.38,258.38,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,23.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,49.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,24.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,20.97,20.97,20.97,14,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,23.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,24.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.75,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,24.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,23.57,448,,facility
AFO ANKLE GAUNTLET PRE OTS,L1902,HCPCS,274,RC,,,,outpatient,,,183,18.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,66,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,61,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,122.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,122.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,125.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,122.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,255.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,129.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,122.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,129.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,124.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,122.31,255.63,,facility
DRAWING OF BLOOD FOR A MEDICAL PROBLEM,99195,CPT,0940,RC,,,,outpatient,,,1197,119.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,113.1,113.1,117.45,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,766.08,766.08,766.08,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,131.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,402.19,402.19,402.19,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,402.19,402.19,402.19,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,266.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,134.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,134.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,418,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,129.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,127.33,448,,facility
UNLISTED MOLECULAR PATHOLOGY,81479,CPT,310,RC,,,,outpatient,,,1890,189,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,561.56,561.56,561.56,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,32.5,32.5,3071.5,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
WRIST HAND ORTHOSIS; WRIST EXTENSION CONTROL COCK-UP; NON MOLDED; PREFABRICATED; OFF-THE-SHELF,L3908,HCPCS,0274,RC,,,,outpatient,,,101,10.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,25.25,25.25,25.25,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,66,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,61,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,67.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,67.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,69.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,67.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,140.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,71.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,67.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,71.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,68.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,67.37,140.8,,facility
BLOOD SPLIT UNIT,P9011,HCPCS,390,RC,,,,outpatient,,,176,17.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,141.8,130.8,155.08,21,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,558.72,558.72,558.72,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,155.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,155.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,159.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,155.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,324.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,164.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,155.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,164.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,107,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,158.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,107,448,,facility
BELOW KNEE FLEX COVER SYSTEM,L5962,HCPCS,274,RC,,,,outpatient,,,1153,115.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,66,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,61,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,776.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,776.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,799.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,776.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1623.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,823.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,776.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,823.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,792.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,776.67,1623.24,,facility
CULTURE AEROBIC QUANT OTHER,87071,CPT,306,RC,,,,outpatient,,,70,7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,9.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,20.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,9.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.41,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,10.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,9.89,448,,facility
DRAINAGE OF FLUID COLLECTION OF ABDOMINAL CAVITY BY TUBE USING IMAGING GUIDANCE,49406,CPT,0361,RC,,,,outpatient,,,6916,691.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1628.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3303.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1675.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1675.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3821,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1612.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3821,,facility
NUCLEAR ANTIGEN ANTIBODY,86235,CPT,302,RC,,,,outpatient,,,189,18.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13,12.5,15.95,11,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,54.91,4.37,90.29,43,percent of total billed charges,,,33.6,,4.37,4.37,53.09,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,22.18,4.24,83.33,13,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,37.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.95,13,15.95,54,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.75,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.93,448,,facility
IMMUNOASSAY QUANT NOS NONAB,83520,CPT,301,RC,,,,outpatient,,,1157,115.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,36,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,66.08,66.08,66.08,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,41.18,24.82,318.38,1 through 10,percent of total billed charges,,,33.6,,37.63,37.63,96.43,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,33.6,23.18,176.4,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,36.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,87,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.22,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.27,448,,facility
RED BLOOD CELLS; LEUKOCYTES REDUCED; IRRADIATED; EACH UNIT,P9040,HCPCS,0390,RC,,,,outpatient,,,2348,234.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,235.95,235.95,264.11,49,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,1502.72,1502.72,3005.44,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,264.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,264.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,272.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,1239.74,788.93,2479.49,1 through 10,percent of total billed charges,,,33.6,,788.93,788.93,1340.71,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,894.59,852.32,894.59,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,264.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,551.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,279.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,493.08,493.08,493.08,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,169.4,169.4,169.4,35,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,264.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,279.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,107,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,269.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,107,551.99,,facility
NUCLEAR ANTIGEN ANTIBODY,86235,CPT,302,RC,,,,outpatient,,,307,30.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13,12.5,15.95,11,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,54.91,4.37,90.29,43,percent of total billed charges,,,33.6,,4.37,4.37,53.09,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,22.18,4.24,83.33,13,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,37.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.95,13,15.95,54,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.75,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.93,448,,facility
GENE ANALYSIS (5; 10-METHYLENETETRAHYDROFOLATE REDUCTASE) COMMON VARIANTS,81291,CPT,0310,RC,,,,outpatient,,,903,90.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,65.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,65.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,67.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,65.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,136.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,69.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,65.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,69.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,114.35,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,66.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,65.34,448,,facility
X-RAY OF SPINE; 1 VIEW,72020,CPT,0320,RC,,,,outpatient,,,537,53.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,85.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,174.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.47,13.47,13.47,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,84.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,83.29,448,,facility
CRITICAL CARE ADDL 30 MIN,99292,CPT,450,RC,,,,outpatient,,,4629,462.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1200,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1500,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,96.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,96.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,99.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,96.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,201.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,102.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,96.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,102.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,98.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,96.63,1500,,facility
TRICHOMONAS VAGINALIS AMPLIF,87661,CPT,306,RC,,,,outpatient,,,360,36,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,57,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,127.44,127.44,127.44,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,114.05,72.58,123.34,1 through 10,percent of total billed charges,,,33.6,,28.9,28.9,114.05,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,72.58,28.9,73.22,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,91,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
PLATELETS; PHERESIS; LEUKOCYTES REDUCED; EACH UNIT,P9035,HCPCS,0390,RC,,,,outpatient,,,6845,684.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,509.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,509.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,524.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,509.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1063.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,539.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,509.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,539.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,107,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,519.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,107,1063.98,,facility
ENZYME CELL ACTIVITY,82657,CPT,301,RC,,,,outpatient,,,494,49.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.72,19.72,19.72,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,2094.14,2094.14,2094.14,1 through 10,percent of total billed charges,,,33.6,,762.96,762.96,762.96,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,46.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,23.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.72,19.72,19.72,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,23.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,39.01,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,22.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,22.17,448,,facility
DIPROPYLACETIC ACID FREE,80165,CPT,301,RC,,,,outpatient,,,75,7.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,28.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.26,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.54,448,,facility
COMPLEMENT ANTIGEN,86160,CPT,302,RC,,,,outpatient,,,236,23.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.67,10.67,10.67,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,87.32,87.32,87.32,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,78.14,49.73,270.86,17,percent of total billed charges,,,33.6,,49.73,49.73,172.37,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,49.73,29.23,50.32,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,256.5,256.5,256.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.67,10.67,10.67,61,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.92,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12,448,,facility
LYME DISEASE ANTIBODY,86618,CPT,302,RC,,,,outpatient,,,175,17.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,35.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.15,15.15,15.15,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.79,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.03,448,,facility
SHANK FT W VERT LOAD PYLON,L5987,HCPCS,274,RC,,,,outpatient,,,13207,1320.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,66,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,61,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Stoploss First Dollar + Reimbursement Rate 50.00 + Percent Of Charge + Reimbursement Rate 0.00 + Fixed Amount 3149.00,,,,0,other,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,Stoploss First Dollar + Reimbursement Rate 50.00 + Percent Of Charge + Reimbursement Rate 0.00 + Fixed Amount 3149.00,,,,0,other,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,8905.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8905.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9172.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8905.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,18611.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,9439.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8905.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,9439.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,9083.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,8905.25,18611.97,,facility
IMFLUOR EA ADDL 1ANTB STN PX,88350,CPT,310,RC,,,,outpatient,,,438,43.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,26.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,55.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,28.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,26.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,28.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,76.23,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,27.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,26.49,448,,facility
CRYSTAL IDENTIFICATION FROM TISSUE OR BODY FLUID,89060,CPT,0309,RC,,,,outpatient,,,269,26.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,90.38,90.38,90.38,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,90.38,90.38,90.38,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,7.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,15.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,7.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,6.52,6.52,6.52,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,7.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,7.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.45,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,7.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,7.33,448,,facility
RBC ANTIBODY ELUTION,86860,CPT,302,RC,,,,outpatient,,,126,12.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,167.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,289.34,289.34,312.91,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,340.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,172.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,172.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,226.07,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,166.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,163.06,448,,facility
INJECTION; DENOSUMAB; 1 MG,J0897,HCPCS,0636,RC,,,,outpatient,,,125,12.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,30.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,7650.15,7650.15,7920,240,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,30.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,62.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,31.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,30.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,31.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,59.47,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,30.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,30.1,448,,facility
CMV ANTIBODY,86644,CPT,302,RC,,,,outpatient,,,526,52.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.8,12.8,12.8,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,30.08,30.08,85.12,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,70.22,44.69,76.56,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,49.24,48.72,49.24,1 through 10,percent of total billed charges,,,34.6,,48.28,17.91,50.67,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,30.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.8,12.8,12.8,11,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,31.1,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.39,448,,facility
ELECTRONIC ANALYSIS OF IMPLANTED NEUROSTIMULATOR GENERATOR WITH SIMPLE SPINAL CORD OR PERIPHERAL NERVE STIMULATOR PROGRAMMING,95971,CPT,0920,RC,,,,outpatient,,,347,34.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,80.53,80.53,87.31,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,90.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,90.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,93.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,90.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,190.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,96.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,34.42,34.42,34.42,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,90.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,96.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,422,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,92.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,90.99,448,,facility
ASSAY BLOOD CARBON DIOXIDE,82374,CPT,301,RC,,,,outpatient,,,473,47.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.34,4.34,4.34,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,9.76,9.76,9.76,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,48.54,28.56,48.54,1 through 10,percent of total billed charges,,,33.6,,28.56,28.56,28.56,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,28.57,28.56,57.12,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,10.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.34,4.34,4.34,35,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.55,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,4.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,4.88,448,,facility
LOWER EXTREMITY STUDY,93925,CPT,921,RC,,,,outpatient,,,3986,398.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,235.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,477.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,242.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,242.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1227,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,232.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,228.36,1227,,facility
FLUORESCENT ANTIBODY SCREEN,86255,CPT,302,RC,,,,outpatient,,,585,58.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.72,10.72,10.72,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,45.41,28.9,1068.67,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,28.9,28.9,28.9,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.72,10.72,10.72,19,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.04,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.05,448,,facility
INTERMEDIATE REPAIR OF WOUND OF FACE; EARS; EYELIDS; NOSE; LIPS; OR MOUTH; 2.6-5.0 CM,12052,CPT,0450,RC,,,,outpatient,,,1129,112.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,350.55,350.55,350.55,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,400.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,644.66,382.73,644.66,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,382.73,382.73,382.73,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,813.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,412.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,355.79,355.79,366.07,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,412.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,396.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,389.05,1173,,facility
HEMOGLOBIN CHROMOTOGRAPHY,83021,CPT,301,RC,,,,outpatient,,,278,27.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.06,16.06,16.06,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,37.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,58.38,58.38,58.38,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.06,16.06,16.06,16,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,39.01,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.06,448,,facility
EVALUATE SWALLOWING FUNCTION,92610,CPT,444,RC,,,,outpatient,,,625,62.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,80,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,80.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,80.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,82.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,80.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,167.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,85.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,61.67,61.67,61.67,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,80.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,85.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,449,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,81.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,80,449,,facility
SIMPLE REPAIR OF SURFACE WOUND OF SCALP; NECK; UNDERARMS; TRUNK; ARMS; OR LEGS; 7.6-12.5 CM,12004,CPT,0450,RC,,,,outpatient,,,1584,158.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,197.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,532.22,532.22,532.22,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,401.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,203.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,176.95,176.95,176.95,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,203.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,195.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,192.01,1173,,facility
BABESIA MICROTI AMP PRB,87469,CPT,306,RC,,,,outpatient,,,758,75.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,61.41,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
BALLOON DILATION OF CORONARY ARTERY OR BRANCH; EACH ADDITIONAL ARTERY OR BRANCH,92921,CPT,0481,RC,,,,outpatient,,,27484,2748.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 6500.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 10000.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 103.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment.",,,,0,other,"Payer contract is 103.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment. + No services performed during 15-month lookback period",,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment. + No services performed during 15-month lookback period",,,"Payer contract is 209.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment.",,,,0,other,"Payer contract is 209.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment. + No services performed during 15-month lookback period",,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment. + No services performed during 15-month lookback period",,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11062,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,"Payer contract is 102.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment.",,,,0,other,"Payer contract is 102.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment. + No services performed during 15-month lookback period",448,11062,,facility
M/PHMTRC ALYS ISHQUANT/SEMIQ,88377,CPT,312,RC,,,,outpatient,,,1321,132.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,150.35,150.35,163,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,464,464,464,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,167.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,443.86,443.86,697.49,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,340.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,172.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,277.91,263.3,277.91,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,172.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,226.07,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,166.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,163.06,448,,facility
PARVOVIRUS ANTIBODY,86747,CPT,302,RC,,,,outpatient,,,271,27.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,31.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.48,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,15.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,15.03,448,,facility
LIPID PANEL,80061,CPT,301,RC,,,,outpatient,,,59,5.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.91,11.91,11.91,1021,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,34.81,34.81,34.81,26,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,37.76,37.76,37.76,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,31.15,19.82,31.15,172,percent of total billed charges,,,33.6,,20,19.82,31.15,37,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,19.82,19.82,20,389,percent of total billed charges,,,34.6,,21.83,21.83,21.83,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,29.5,29.5,123.5,11,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,12.39,12.39,51.87,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.91,11.91,11.91,1133,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.93,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.39,448,,facility
IMMUNOASSAY INFECTIOUS AGENT,86317,CPT,302,RC,,,,outpatient,,,57,5.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.33,13.33,13.33,86,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,59,59,59,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,52.8,26.54,52.8,41,percent of total billed charges,,,33.6,,52.8,33.6,52.8,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,33.6,33.6,33.73,52,percent of total billed charges,,,34.6,,218.53,218.53,218.53,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,31.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,50,50,50,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.33,13.33,13.33,209,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.38,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,15.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.99,448,,facility
INJECTION INTO SKIN GROWTH; 1-7 GROWTHS,11900,CPT,0761,RC,,,,outpatient,,,1584,158.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,174.34,174.34,180.67,25,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,197.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,401.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,203.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,176.95,176.95,176.95,40,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,203.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,1031.25,1031.25,1031.25,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,195.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,192.01,1173,,facility
ENDO AK ULTRA-LIGHT MATERIAL,L5950,HCPCS,274,RC,,,,outpatient,,,1884,188.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,66,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,61,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1269.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1269.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1308.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1269.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,2654.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1346.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1269.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1346.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,1295.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,1269.97,2654.24,,facility
TEST SOCKET ABOVE KNEE,L5624,HCPCS,274,RC,,,,outpatient,,,881,88.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,66,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,61,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,593.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,593.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,611.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,593.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1240.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,629.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,593.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,629.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,605.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,593.44,1240.29,,facility
X-RAY SERIES OF ABDOMEN WITH SINGLE X-RAY OF CHEST,74022,CPT,0320,RC,,,,outpatient,,,1552,155.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,28.04,28.04,28.04,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,448,,facility
CULTURE AEROBIC IDENTIFY,87077,CPT,306,RC,,,,outpatient,,,119,11.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,7.19,7.19,7.19,67,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,101.48,25.96,101.48,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,90.82,57.79,154.46,34,percent of total billed charges,,,33.6,,57.79,53.5,90.82,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,57.79,14.92,58.31,28,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,16.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,86,86,172,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,36.12,36.12,36.12,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,7.19,7.19,7.19,240,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.45,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,8.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,8.08,448,,facility
UNLISTD PX SKN MUC MEMB SUBQ,17999,CPT,761,RC,,,,outpatient,,,1742,174.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,197.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,401.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,203.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,203.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,195.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,192.01,1173,,facility
ENZYME CELL ACTIVITY,82657,CPT,301,RC,,,,outpatient,,,1011,101.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.72,19.72,19.72,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,2094.14,2094.14,2094.14,1 through 10,percent of total billed charges,,,33.6,,762.96,762.96,762.96,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,46.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,23.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.72,19.72,19.72,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,23.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,39.01,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,22.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,22.17,448,,facility
X-RAY OF ANKLE; MINIMUM OF 3 VIEWS,73610,CPT,0320,RC,,,,outpatient,,,849,84.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,85.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,174.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,22.64,22.64,23.58,88,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,84.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,83.29,448,,facility
FUNGAL CULTURE; YEAST,87106,CPT,0306,RC,,,,outpatient,,,206,20.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,21.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9.18,9.18,9.18,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.3,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,10.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,10.32,448,,facility
CARBON DIOXIDE (BICARBONATE) LEVEL,82374,CPT,0301,RC,,,,outpatient,,,85,8.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.34,4.34,4.34,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,9.76,9.76,9.76,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,48.54,28.56,48.54,1 through 10,percent of total billed charges,,,33.6,,28.56,28.56,28.56,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,28.57,28.56,57.12,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,10.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.34,4.34,4.34,35,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.55,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,4.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,4.88,448,,facility
FLOWCYTOMETRY/ TC 1 MARKER,88184,CPT,311,RC,,,,outpatient,,,881,88.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,315.62,315.62,343.05,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,546.56,546.56,731.52,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,343.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,343.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,353.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,286.94,286.94,384.05,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,343.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,716.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,363.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,179.34,179.34,179.34,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,63.07,63.07,165.15,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,343.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,363.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,377,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,349.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,343.05,716.97,,facility
NERVE CONDUCTION; 9-10 STUDIES,95911,CPT,0922,RC,,,,outpatient,,,1851,185.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,465.55,465.55,465.55,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,357.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,357.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,367.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,357.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,746.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,378.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,68.57,68.57,68.57,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,357.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,378.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,478,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,364.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,357.13,746.4,,facility
ASSAY NEPHELOMETRY NOT SPEC,83883,CPT,301,RC,,,,outpatient,,,489,48.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.1,12.1,12.1,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,173.18,51.22,173.18,1 through 10,percent of total billed charges,,,33.6,,31.58,31.58,31.58,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,31.58,31.53,110.21,11,percent of total billed charges,,,34.6,,119.06,117.35,124.97,24,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,28.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.1,12.1,12.1,29,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.38,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.6,448,,facility
ASSAY OF URINE SODIUM,84300,CPT,301,RC,,,,outpatient,,,93,9.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.5,4.5,4.5,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,62.16,62.16,62.72,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,10.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,21.5,21.5,92.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.5,4.5,4.5,20,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.5,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.06,448,,facility
NUCLEAR ANTIGEN ANTIBODY,86235,CPT,302,RC,,,,outpatient,,,233,23.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13,12.5,15.95,11,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,54.91,4.37,90.29,43,percent of total billed charges,,,33.6,,4.37,4.37,53.09,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,22.18,4.24,83.33,13,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,37.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.95,13,15.95,54,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.75,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.93,448,,facility
CHEMICAL ANALYSIS USING SPECTROPHOTOMETRY (LIGHT),84311,CPT,0301,RC,,,,outpatient,,,101,10.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,7.2,7.2,7.2,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,45.35,45.35,53.33,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,16.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,7.2,7.2,7.2,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.1,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,8.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,8.1,448,,facility
X-RAY OF ABDOMEN; 2 VIEWS,74019,CPT,0320,RC,,,,outpatient,,,993,99.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,635.52,635.52,635.52,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,567,333.65,567,22,percent of total billed charges,,,33.6,,333.65,333.65,333.65,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,333.65,333.65,336.63,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,496.5,496.5,496.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,496.5,496.5,496.5,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,21.02,21.02,21.64,382,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,448,,facility
DIAGNOSTIC EXAM OF NASAL PASSAGES USING AN ENDOSCOPE,31231,CPT,0450,RC,,,,outpatient,,,917,91.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,165.8,159.46,170.34,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,191.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,191.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,196.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,191.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,399.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,202.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,172.88,172.88,172.88,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,191.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,202.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,194.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,191.04,1311,,facility
APPLICATION OF LOWER AND UPPER ARM SPLINT,29105,CPT,0450,RC,,,,outpatient,,,261,26.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,138.44,138.44,143.45,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,155.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,155.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,160.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,155.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,325.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,164.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,155.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,164.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,158.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,155.52,448,,facility
CLOSED TREATMENT OF BROKEN MIDDLE PART OF UPPER ARM BONE WITH MANIPULATION,24505,CPT,0450,RC,,,,outpatient,,,3201,320.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1585.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3216.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1631.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1631.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1569.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3216.38,,facility
CYP2D6 GENE COM VARIANTS,81226,CPT,310,RC,,,,outpatient,,,650,65,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,450.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,450.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,464.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,450.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,942.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,477.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,450.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,477.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,789.09,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,459.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,942.4,,facility
IMMUNOASSAY QUANT NOS NONAB,83520,CPT,301,RC,,,,outpatient,,,639,63.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,36,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,66.08,66.08,66.08,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,41.18,24.82,318.38,1 through 10,percent of total billed charges,,,33.6,,37.63,37.63,96.43,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,33.6,23.18,176.4,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,36.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,87,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.22,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.27,448,,facility
SLEEP STUDY; MULTIPLE TRIALS,95805,CPT,0740,RC,,,,outpatient,,,4734,473.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,821.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,821.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,846.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,2499.55,2499.55,2499.55,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,1604.83,1604.83,1604.83,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,821.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1717.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,871.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,821.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,871.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1175,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,838.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1717.69,,facility
ROUTINE ELECTROCARDIOGRAM (ECG) USING AT LEAST 12 LEADS WITH TRACING,93005,CPT,0730,RC,,,,outpatient,,,532,53.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,52.12,52.08,56.46,233,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,340.48,340.48,340.48,88,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,313.88,313.88,313.88,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,56.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,56.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,58.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,280.9,178.75,303.78,191,percent of total billed charges,,,33.6,,180.35,178.75,303.77,38,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,178.75,178.75,180.35,118,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,56.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,118,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,59.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,266,266,266,13,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,111.72,111.72,111.72,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.1,5.1,5.25,2124,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,56.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,59.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,389,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,57.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,56.46,448,,facility
STOOL CULTURE; ADDITIONAL PATHOGENS,87046,CPT,0306,RC,,,,outpatient,,,187,18.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,62.83,62.83,62.83,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,9.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,19.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,9.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.41,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,9.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,9.44,448,,facility
ASSAY AMINOLEVULINIC ACID,82135,CPT,301,RC,,,,outpatient,,,60,6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,14.63,14.63,14.63,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,34.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.54,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,16.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,16.45,448,,facility
MYCOPLASMA ANTIBODY,86738,CPT,302,RC,,,,outpatient,,,239,23.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.78,11.78,11.78,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.6,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.24,448,,facility
RED BLOOD COUNT; AUTOMATED TEST,85045,CPT,0305,RC,,,,outpatient,,,213,21.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.55,3.55,3.55,82,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,112.46,16.13,112.46,40,percent of total billed charges,,,33.6,,16.13,16.13,16.13,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,16.13,16.13,71.57,12,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,8.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,24,23.88,24,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,44.73,44.73,44.73,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.55,3.55,3.55,284,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.63,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,4.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,3.99,448,,facility
TREPONEMA PALLIDUM,86780,CPT,302,RC,,,,outpatient,,,50,5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.78,11.78,11.78,612,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,10.62,10.62,50.15,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,9.5,6.05,48.53,46,percent of total billed charges,,,33.6,,6.05,6.05,44.88,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,6.05,6.05,28.56,66,percent of total billed charges,,,34.6,,73.69,20.19,77.34,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,9,9,42.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,17.85,17.85,17.85,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,11.78,11.78,11.78,1 through 10,percent of total billed charges,,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.78,11.78,11.78,550,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.6,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.24,448,,facility
ASSAY ALKALINE PHOSPHATASES,84080,CPT,301,RC,,,,outpatient,,,257,25.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.15,13.15,13.15,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,12.43,12.43,12.43,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,12.43,12.43,12.54,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,30.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.15,13.15,13.15,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,31.94,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,15.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.78,448,,facility
X-RAY OF SOFT TISSUE OF NECK,70360,CPT,0320,RC,,,,outpatient,,,951,95.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,85.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,174.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,18.33,18.33,18.86,12,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,84.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,83.29,448,,facility
ASSAY PH BODY FLUID NOS,83986,CPT,301,RC,,,,outpatient,,,33,3.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.18,3.18,3.18,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,75.43,75.43,75.43,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,7.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.18,3.18,3.18,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.74,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,3.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,3.58,448,,facility
GENE ANALYSIS (ISOCITRATE DEHYDROGENASE 1 [NADP+]; SOLUBLE) FOR COMMON VARIANTS,81120,CPT,0310,RC,,,,outpatient,,,263,26.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,193.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,193.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,199.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,89.16,89.16,89.16,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,193.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,403.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,204.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,193.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,204.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,338.19,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,197.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,193.25,448,,facility
MOLECULAR PATHOLOGY PROCEDURE LEVEL 4,81403,CPT,0310,RC,,,,outpatient,,,380,38,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,185.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,185.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,190.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,322.39,322.39,322.39,1 through 10,percent of total billed charges,,,34.6,,397.12,397.12,397.12,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,185.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,387.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,196.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,185.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,196.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,324.1,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,188.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,185.2,448,,facility
MOPATH PROCEDURE LEVEL 7,81406,CPT,310,RC,,,,outpatient,,,288,28.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,282.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,282.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,291.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,282.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,591.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,299.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,282.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,299.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,495.04,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,288.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,282.88,591.22,,facility
STOOL ANALYSIS FOR BLOOD; BY PEROXIDASE ACTIVITY,82272,CPT,0301,RC,,,,outpatient,,,48,4.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.76,3.76,3.76,11,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,8.96,8.96,8.96,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,4.7,4.7,7.39,1 through 10,percent of total billed charges,,,33.6,,7.39,7.39,7.39,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,8.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,24,24,24,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.76,3.76,3.76,31,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.4,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,4.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,4.23,448,,facility
MUMPS ANTIBODY,86735,CPT,302,RC,,,,outpatient,,,283,28.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.61,11.61,11.61,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,22.18,22.18,85.01,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,68.61,68.61,68.61,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,44,44,44,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.61,11.61,11.61,15,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.19,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.05,448,,facility
X-RAY EXAM KNEE 4 OR MORE,73564,CPT,320,RC,,,,outpatient,,,2281,228.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,448,,facility
X-RAY OF ENTIRE MIDDLE AND LOWER SPINE; 1 VIEW,72081,CPT,0320,RC,,,,outpatient,,,844,84.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,540.16,540.16,540.16,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,85.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,283.58,283.58,445.63,1 through 10,percent of total billed charges,,,33.6,,283.58,283.58,283.58,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,174.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,84.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,83.29,448,,facility
COMPLEMENT ANTIGEN,86160,CPT,302,RC,,,,outpatient,,,676,67.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.67,10.67,10.67,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,87.32,87.32,87.32,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,78.14,49.73,270.86,17,percent of total billed charges,,,33.6,,49.73,49.73,172.37,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,49.73,29.23,50.32,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,256.5,256.5,256.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.67,10.67,10.67,61,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.92,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12,448,,facility
HEMOGLOBIN A1C LEVEL,83036,CPT,0301,RC,,,,outpatient,,,218,21.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,8.64,8.64,8.64,577,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,34.22,33.93,128.62,24,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,30.62,19.49,115.1,181,percent of total billed charges,,,33.6,,19.49,19.49,73.25,32,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,19.49,19.49,19.49,332,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,9.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,20.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,29,28.75,29,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,12.18,12.08,45.78,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,8.64,8.64,8.64,1 through 10,percent of total billed charges,,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,8.64,8.64,8.64,1281,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,9.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.98,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,9.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,9.71,448,,facility
ELEC KNEE-SHIN SWING/STANCE,L5856,HCPCS,274,RC,,,,outpatient,,,44070,4407,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,66,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,61,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Stoploss First Dollar + Reimbursement Rate 50.00 + Percent Of Charge + Reimbursement Rate 0.00 + Fixed Amount 3149.00,,,,0,other,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,Stoploss First Dollar + Reimbursement Rate 50.00 + Percent Of Charge + Reimbursement Rate 0.00 + Fixed Amount 3149.00,,,,0,other,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,29717.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29717.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30608.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,29717.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,62108.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,31500.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,29717.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,31500.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,30311.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,29717.2,62108.95,,facility
REMOVAL OF DEFECT IN WALL OF ESOPHAGUS USING A RIGID ENDOSCOPE,43180,CPT,0750,RC,,,,outpatient,,,15382,1538.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 6500.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 10000.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,5665.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5665.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5835.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5665.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,11841.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6005.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5665.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6005.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9389,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5778.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,11841.12,,facility
ANALYSIS FOR ANTIBODY TO RUBELLA (GERMAN MEASLES VIRUS),86762,CPT,0302,RC,,,,outpatient,,,48,4.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.8,12.8,12.8,18,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,28.32,28.32,28.32,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,25.34,16.13,25.34,14,percent of total billed charges,,,33.6,,16.13,16.13,16.13,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,16.13,16.13,16.27,22,percent of total billed charges,,,34.6,,68.61,68.61,68.61,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,30.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,24,24,44.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,12.8,12.8,12.8,1 through 10,percent of total billed charges,,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.8,12.8,12.8,185,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,31.1,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.39,448,,facility
DETECT AGNT MULT DNA AMPLI,87801,CPT,306,RC,,,,outpatient,,,1397,139.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,70.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,70.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,72.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,70.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,146.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,74.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,62.44,62.44,62.44,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,70.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,74.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,151.66,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,71.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,70.2,448,,facility
SIMPLE REPAIR OF SURFACE WOUND OF FACE; EARS; EYELIDS; NOSE; LIPS; OR MOUTH; 2.5 CM OR LESS,12011,CPT,0361,RC,,,,outpatient,,,1584,158.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,197.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,401.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,203.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,203.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2440,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,195.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,192.01,2440,,facility
CCP ANTIBODY,86200,CPT,302,RC,,,,outpatient,,,336,33.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.52,11.52,11.52,14,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,70.8,70.8,70.8,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,63.36,25.87,63.36,1 through 10,percent of total billed charges,,,33.6,,40.32,40.32,63.36,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,33.26,16.46,40.68,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.52,11.52,11.52,56,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.97,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.95,448,,facility
DIAGNOSTIC EXAM OF SMALL BOWEL USING AN ENDOSCOPE INSERTED THROUGH SURGICALLY CREATED OPENING FROM SMALL BOWEL TO SKIN,44380,CPT,0750,RC,,,,outpatient,,,4087,408.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,868.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,868.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,894.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,868.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1814.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,920.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,868.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,920.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3821,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,885.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3821,,facility
SPECIAL CASTING MATERIAL,A4590,HCPCS,270,RC,,,,outpatient,,,102,10.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,329.68,329.68,329.68,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,153.59,72.24,8612.62,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
FLUORESCENT ANTIBODY SCREEN,86255,CPT,302,RC,,,,outpatient,,,65,6.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.72,10.72,10.72,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,45.41,28.9,1068.67,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,28.9,28.9,28.9,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.72,10.72,10.72,19,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.04,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.05,448,,facility
HEPATITIS DELTA AGENT ANTBDY,86692,CPT,302,RC,,,,outpatient,,,2400,240,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,35.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,37.08,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.16,448,,facility
MANGANESE (HEAVY METAL) LEVEL,83785,CPT,0301,RC,,,,outpatient,,,93.65,9.37,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,26.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,55.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,28.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,23.7,23.7,23.7,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,26.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,28.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,53.15,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,27.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,26.65,448,,facility
ASSAY OF MERCURY,83825,CPT,301,RC,,,,outpatient,,,51,5.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,14.46,14.46,14.46,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,33.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,14.46,14.46,14.46,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.12,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,16.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,16.26,448,,facility
DETECT AGENT NOS DNA AMP,87798,CPT,306,RC,,,,outpatient,,,1461,146.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,110.88,110.88,174.24,1 through 10,percent of total billed charges,,,33.6,,244.27,244.27,244.27,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,96.77,32.38,119.79,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,38.9,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
ASSAY FOR PHENCYCLIDINE,83992,CPT,301,RC,,,,outpatient,,,1008,100.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.6,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,75.6,448,,facility
PROLACTIN (MILK PRODUCING HORMONE) LEVEL,84146,CPT,0301,RC,,,,outpatient,,,73.5,7.35,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,17.24,17.24,17.24,56,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,43.66,43.66,43.66,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,39.07,24.86,139.92,20,percent of total billed charges,,,33.6,,89.04,89.04,139.92,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,24.86,24.86,89.04,15,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,40.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,20.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,36.75,36.75,37,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,15.54,15.54,15.54,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,17.24,17.24,17.24,96,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,20.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,41.86,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,19.38,448,,facility
ANALYSIS FOR ANTIBODY TO BLASTOMYCES (FUNGUS),86612,CPT,0302,RC,,,,outpatient,,,70,7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,26.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.88,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.9,448,,facility
SLEEP STUDY IN SLEEP LAB WITH CONTINUOUS AIRWAY PRESSURE (6 YEARS OR OLDER),95811,CPT,0740,RC,,,,outpatient,,,11300,1130,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,892.66,758.08,892.66,13,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,7232,7232,7232,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,821.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,821.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,846.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,5966.4,5966.4,5966.4,1 through 10,percent of total billed charges,,,33.6,,3796.8,3796.8,3796.8,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,821.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1717.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,871.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,2373,2373,2373,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,433.54,433.54,442.82,16,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,821.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,871.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1175,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,838.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1717.69,,facility
COMPLEMENT/FUNCTION ACTIVITY,86161,CPT,302,RC,,,,outpatient,,,400,40,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.92,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12,448,,facility
NERVE CONDUCTION; 5-6 STUDIES,95909,CPT,0922,RC,,,,outpatient,,,1018,101.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,273.22,273.22,273.22,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,206.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,206.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,212.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,206.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,431.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,219.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,44.5,44.5,47.18,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,206.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,219.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,478,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,210.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,206.65,478,,facility
HEPATITIS B DNA QUANT,87517,CPT,306,RC,,,,outpatient,,,1327,132.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,38.11,38.11,38.11,15,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,44.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,95.04,95.04,355.34,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,60.48,60.48,95.09,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,89.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,45.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,90,90,90,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,38.11,38.11,38.11,25,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,45.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,92.54,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,43.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,42.84,448,,facility
PROTECT BODY SOCK EA PRE OTS,L0984,HCPCS,274,RC,,,,outpatient,,,105,10.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,66,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,61,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,69.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,69.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,71.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,69.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,145.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,73.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,69.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,73.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,71.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,69.77,145.82,,facility
TEST TO MEASURE LUNG AIRWAY SENSITIVITY,94070,CPT,0460,RC,,,,outpatient,,,4295,429.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,273.22,273.22,296.21,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,2748.8,2748.8,2748.8,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,357.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,357.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,367.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,357.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,746.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,378.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,29.37,29.37,29.37,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,357.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,378.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,611,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,364.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,357.13,746.4,,facility
ASSAY OF CITRATE,82507,CPT,301,RC,,,,outpatient,,,187,18.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,27.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,58.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,29.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,27.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,29.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,60.08,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,28.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,27.8,448,,facility
DRUG ASSAY VORICONAZOLE,80285,CPT,301,RC,,,,outpatient,,,200,20,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,24.11,24.11,24.11,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,27.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,56.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,28.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,24.11,24.11,24.11,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,27.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,28.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,47.44,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,27.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,27.11,448,,facility
CATH W/DRAINAGE 2-WAY LATEX,A4314,HCPCS,272,RC,,,,outpatient,,,57,5.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",448,448,,facility
RICKETTSIA ANTIBODY,86757,CPT,302,RC,,,,outpatient,,,76,7.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,17.21,17.21,17.21,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,40.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,20.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,17.21,17.21,17.21,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,20.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,41.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,19.35,448,,facility
SCREENING TEST FOR RED BLOOD CELL ANTIBODIES,86850,CPT,0302,RC,,,,outpatient,,,435,43.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,46.88,46,50.82,18,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,256.65,37.76,256.65,13,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,49.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,49.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,51.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,146.16,33.66,248.39,115,percent of total billed charges,,,33.6,,146.16,33.66,146.16,44,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,146.16,21.5,165.73,78,percent of total billed charges,,,34.6,,165.73,157.9,315.81,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,49.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,104.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,52.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,32,31.88,217.5,14,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,91.35,13.44,91.35,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,8.69,8.69,8.69,1 through 10,percent of total billed charges,,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,8.69,8.69,8.69,811,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,49.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,52.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.1,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,50.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.1,448,,facility
UNLISTED MOLECULAR PATHOLOGY,81479,CPT,310,RC,,,,outpatient,,,2440,244,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,561.56,561.56,561.56,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,32.5,32.5,3071.5,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
PANITUMUMAB INJECTION,J9303,HCPCS,636,RC,,,,outpatient,,,231,23.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,182.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,182.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,187.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,182.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,380.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,193.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,182.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,193.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,356.28,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,185.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,182.19,448,,facility
CONTRAST X-RAY OF SHOULDER,73040,CPT,322,RC,,,,outpatient,,,4670,467,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,333.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,333.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,343.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,333.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,697.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,353.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,333.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,353.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,340.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,333.9,697.85,,facility
FLUORESCENT ANTIBODY TITER,86256,CPT,302,RC,,,,outpatient,,,238,23.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.72,10.72,10.72,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.04,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.05,448,,facility
DETECT AGENT NOS DNA AMP,87798,CPT,306,RC,,,,outpatient,,,601,60.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,110.88,110.88,174.24,1 through 10,percent of total billed charges,,,33.6,,244.27,244.27,244.27,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,96.77,32.38,119.79,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,38.9,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
QUANTITATIVE ASSAY DRUG,80299,CPT,301,RC,,,,outpatient,,,100,10,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,13,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,174.64,174.64,174.64,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,171.6,171.6,171.6,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,374.52,374.52,374.52,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.62,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.64,448,,facility
SPECIMEN INFECT AGNT CONCNTJ,87015,CPT,306,RC,,,,outpatient,,,86,8.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.94,5.94,5.94,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,13.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,7.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.94,5.94,5.94,23,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,7.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.42,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,6.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,6.68,448,,facility
OBTAINING RESPIRATORY DATA NEEDED TO DEVELOP THE OPTIMAL RADIATION TREATMENT,77293,CPT,0333,RC,,,,outpatient,,,4336.25,433.63,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,2775.2,2775.2,2775.2,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,99.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,99.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,102.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,99.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,208.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,105.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,99.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,105.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,48815,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,101.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,99.76,48815,,facility
BLOOD GASES MEASUREMENT,82803,CPT,0301,RC,,,,outpatient,,,265,26.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,23.19,23.19,23.19,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,182.16,115.92,197,26,percent of total billed charges,,,33.6,,115.92,107.14,115.92,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,115.92,89.84,228.59,16,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,26.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,54.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,27.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,172.5,172.5,172.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,23.19,23.19,23.19,245,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,26.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,27.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,45.62,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,26.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,26.07,448,,facility
TOTAL CORTISOL,82533,CPT,301,RC,,,,outpatient,,,88,8.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,14.5,14.5,14.5,28,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,68.44,68.44,68.44,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,203.28,61.25,203.28,34,percent of total billed charges,,,33.6,,203.28,129.36,203.28,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,129.36,29.57,130.52,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,34.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,192.5,58,192.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,14.5,14.5,14.5,104,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.21,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,16.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,16.3,448,,facility
CARBON GRAPHITE LAMINATION,L2755,HCPCS,274,RC,,,,outpatient,,,241,24.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,66,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,61,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,161.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,161.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,166.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,161.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,337.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,171.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,161.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,171.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,164.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,161.48,337.49,,facility
MECHANICAL TRACTION THERAPY,97012,CPT,420,RC,,,,outpatient,,,229,22.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,51.96,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,89.84,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,80,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,28.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,422,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.64,448,,facility
THERAPY PROCEDURE USING A POSITIVE PRESSURE VENTILATOR,94660,CPT,0410,RC,,,,inpatient,,,1250,125,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Short Stay Lesser of + Days Threshold 1.00 + Stoploss First Dollar + Reimbursement Rate 57.00 + Basic Per Diem + Fixed Rate 5000.00 + Fixed Amount 157464.00,,,,0,other,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,Short Stay Lesser of + Days Threshold 1.00 + Stoploss First Dollar + Reimbursement Rate 72.00 + Basic Per Diem + Fixed Rate 10000.00 + Fixed Amount 56687.00,,,,0,other,NTE Percentage + Reimbursement Rate 85.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,47.3,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,355.93,355.93,355.93,1 through 10,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,facility
QUANTITATIVE ASSAY DRUG,80299,CPT,301,RC,,,,outpatient,,,355,35.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,13,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,174.64,174.64,174.64,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,171.6,171.6,171.6,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,374.52,374.52,374.52,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.62,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.64,448,,facility
ADENOVIRUS AG IF,87260,CPT,306,RC,,,,outpatient,,,111,11.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,30.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.9,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.43,448,,facility
HISTOPLASMA ANTIBODY,86698,CPT,302,RC,,,,outpatient,,,228,22.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.27,12.27,12.27,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,28.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.27,12.27,12.27,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.79,448,,facility
ASSAY OF PHENYTOIN FREE,80186,CPT,301,RC,,,,outpatient,,,507,50.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,73.92,73.92,73.92,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,28.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.24,12.24,12.24,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.73,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.76,448,,facility
REMOVAL OF NONCANCER SKIN GROWTH OF BODY; ARMS; OR LEGS; 2.1-3.0 CM,11403,CPT,0761,RC,,,,outpatient,,,2910,291,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,625.13,617.33,637.68,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,677.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,677.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,698.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,677.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1416.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,718.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,626.56,626.56,626.56,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,677.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,718.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,691.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1416.43,,facility
ASSAY OF PHENYTOIN TOTAL,80185,CPT,301,RC,,,,outpatient,,,163,16.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,70.22,70.22,70.22,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,44.69,44.69,44.69,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.79,11.79,11.79,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.63,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.25,448,,facility
HPV HI-RISK TYP POOLED RSLT,87624,CPT,306,RC,,,,outpatient,,,97,9.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,51,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,57.23,57.23,57.23,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,85.34,51.22,134.11,1 through 10,percent of total billed charges,,,33.6,,32.59,32.59,85.34,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,85.34,75.94,85.34,14,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,112,48.5,112,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,20.37,20.37,53.34,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,80,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
CYTOGENETICS 100-300,88275,CPT,311,RC,,,,outpatient,,,806,80.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,45.53,45.53,45.53,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,51.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,51.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,52.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,1828.51,1828.51,1828.51,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,401.18,401.18,401.18,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,51.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,106.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,54.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,45.53,45.53,45.53,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,51.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,54.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,89.58,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,52.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,51.19,448,,facility
QUANTITATIVE ASSAY DRUG,80299,CPT,301,RC,,,,outpatient,,,317,31.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,13,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,174.64,174.64,174.64,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,171.6,171.6,171.6,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,374.52,374.52,374.52,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.62,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.64,448,,facility
DEHYDROEPIANDROSTERONE,82626,CPT,301,RC,,,,outpatient,,,287,28.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,22.48,22.48,22.48,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,29.9,29.9,29.9,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,25.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,52.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,26.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,22.48,22.48,22.48,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,25.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,26.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,54.6,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,25.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,25.27,448,,facility
FLUORESCENT ANTIBODY TITER,86256,CPT,302,RC,,,,outpatient,,,285,28.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.72,10.72,10.72,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.04,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.05,448,,facility
INJECTION OF CHEMOTHERAPY VIA RESERVOIR UNDER SKIN,96542,CPT,0331,RC,,,,outpatient,,,705,70.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,316.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,316.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,325.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,316.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,660.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,335.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,295.37,295.37,295.37,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,316.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,335.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1603,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,322.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,316.12,1603,,facility
X-RAY OF PELVIS; 1-2 VIEWS,72170,CPT,0320,RC,,,,outpatient,,,845,84.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,540.8,498.55,540.8,24,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,498.55,498.55,498.55,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,446.16,283.92,482.5,51,percent of total billed charges,,,33.6,,283.92,283.92,446.16,14,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,283.92,283.92,286.46,28,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,422.5,422.5,422.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.9,15.9,16.36,99,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,448,,facility
IMMUNOASSAY QUANT NOS NONAB,83520,CPT,301,RC,,,,outpatient,,,600,60,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,36,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,66.08,66.08,66.08,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,41.18,24.82,318.38,1 through 10,percent of total billed charges,,,33.6,,37.63,37.63,96.43,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,33.6,23.18,176.4,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,36.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,87,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.22,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.27,448,,facility
GENE REARRANGEMENT ANALYSIS (IMMUNOGLOBULIN KAPPA LIGHT CHAIN LOCUS) TO DETECT ABNORMAL CLONAL POPULATION,81264,CPT,0310,RC,,,,outpatient,,,1088,108.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,172.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,172.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,177.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,365.57,365.57,365.57,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,172.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,361.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,183.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,172.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,183.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,322.61,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,176.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,172.73,448,,facility
DRAINAGE OF ABSCESS OF EAR CANAL,69020,CPT,0450,RC,,,,outpatient,,,1909,190.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,617.33,617.33,617.33,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,677.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,677.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,698.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,677.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1416.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,718.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,677.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,718.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,691.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1416.43,,facility
HC NP RX 250 PAP MEDICATIONS,25000000NP125,CDM,250,RC,,,,inpatient,,,0.01,,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Short Stay Lesser of + Days Threshold 1.00 + Stoploss First Dollar + Reimbursement Rate 57.00 + Basic Per Diem + Fixed Rate 5000.00 + Fixed Amount 157464.00,,,,0,other,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,Short Stay Lesser of + Days Threshold 1.00 + Stoploss First Dollar + Reimbursement Rate 72.00 + Basic Per Diem + Fixed Rate 10000.00 + Fixed Amount 56687.00,,,,0,other,NTE Percentage + Reimbursement Rate 85.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,facility
CERV SR 2PC THOR EXT PRE OTS,L0174,HCPCS,274,RC,,,,outpatient,,,470,47,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,66,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,61,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,315.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,315.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,325.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,315.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,659.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,334.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,315.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,334.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,321.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,315.67,659.75,,facility
ASSAY BLD/SERUM CHOLESTEROL,82465,CPT,301,RC,,,,outpatient,,,362,36.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.87,3.87,3.87,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,20.83,20.83,20.83,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,9.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.87,3.87,3.87,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.4,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,4.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,4.35,448,,facility
DRESSING CHANGE OR REMOVAL OF BURN TISSUE; MORE THAN 10% OF TOTAL BODY SURFACE,16030,CPT,0450,RC,,,,outpatient,,,954,95.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,350.55,350.55,350.55,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,400.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,544.73,544.73,544.73,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,813.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,412.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,366.07,366.07,366.07,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,412.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,396.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,389.05,1311,,facility
ASSAY OF THYROID (T3 OR T4),84479,CPT,301,RC,,,,outpatient,,,53,5.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.75,5.75,5.75,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,70.56,27.98,119.91,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,17.97,17.81,70.56,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,13.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.75,5.75,5.75,23,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.97,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,6.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,6.47,448,,facility
HAPTOGLOBIN (SERUM PROTEIN) LEVEL,83010,CPT,0301,RC,,,,outpatient,,,271,27.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.19,11.19,11.19,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,143.09,143.09,143.09,21,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,31.92,31.92,91.06,1 through 10,percent of total billed charges,,,34.6,,98.37,98.37,98.37,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,26.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,56.91,56.91,56.91,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.19,11.19,11.19,23,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.18,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.58,448,,facility
NFCT AGT GNTYP ALYS HIV1,87906,CPT,306,RC,,,,outpatient,,,580,58,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,120.95,120.95,120.95,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,128.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,128.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,132.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,108.24,108.24,108.24,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,128.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,269.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,136.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,114.5,114.5,114.5,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,128.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,136.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,278.11,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,131.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,128.73,448,,facility
ISLET CELL ANTIBODY,86341,CPT,302,RC,,,,outpatient,,,398,39.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,20.97,20.97,20.97,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,23.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,23.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,143.62,143.62,326.83,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,258.38,258.38,258.38,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,23.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,49.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,24.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,20.97,20.97,20.97,14,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,23.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,24.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.75,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,24.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,23.57,448,,facility
CLOSED TREATMENT OF 3 BROKEN LOWER LEG BONES AT ANKLE WITH MANIPULATION,27818,CPT,0450,RC,,,,outpatient,,,2910,291,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1585.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3216.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1631.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1631.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1569.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3216.38,,facility
HLA I TYPING COMPLETE LR,81372,CPT,300,RC,,,,outpatient,,,501,50.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,403.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,403.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,415.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,403.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,843.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,427.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,403.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,427.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,706.28,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,411.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,403.59,843.5,,facility
BILIRUBIN TOTAL,82247,CPT,301,RC,,,,outpatient,,,33,3.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.47,4.47,4.47,72,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,19.47,19.47,221.84,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,376,376,376,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,214.7,17.42,214.7,80,percent of total billed charges,,,33.6,,126.34,11.09,198.53,22,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,126.34,11.09,127.46,57,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,10.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,16.5,16.5,188,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,6.93,6.93,6.93,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.47,4.47,4.47,682,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.02,448,,facility
GENOME SEQUENCE ANALYSIS,81425,CPT,310,RC,,,,outpatient,,,1275,127.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5031.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5031.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5182.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5031.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,10515.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5333.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5031.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5333.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8804.6,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5131.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,10515.21,,facility
KNEE-SHIN EXO FLUID SWING PH,L5724,HCPCS,274,RC,,,,outpatient,,,3623,362.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,66,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,61,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Stoploss First Dollar + Reimbursement Rate 50.00 + Percent Of Charge + Reimbursement Rate 0.00 + Fixed Amount 3149.00,,,,0,other,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,Stoploss First Dollar + Reimbursement Rate 50.00 + Percent Of Charge + Reimbursement Rate 0.00 + Fixed Amount 3149.00,,,,0,other,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,2463.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2463.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2537.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2463.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,5149.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2611.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2463.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2611.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,2513.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,2463.86,5149.47,,facility
MEASUREMENT OF ANTIBODY FOR ASSESSMENT OF AUTOIMMUNE DISORDER; TITER,86039,CPT,0302,RC,,,,outpatient,,,5,0.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5,5,5,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,11.76,11.76,11.76,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,1.68,1.68,1.68,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,23.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9.93,5,9.93,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.12,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,11.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.16,448,,facility
CT SCAN OF FACE WITH CONTRAST,70487,CPT,0351,RC,,,,outpatient,,,5913,591.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,156.2,154.84,381.77,32,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,403,,,,,,,case rate,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,371,,,,,,,case rate,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,411,411,411,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,875,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1050,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,172.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,3376.32,3376.32,3376.32,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,1986.77,1986.77,1986.77,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,350.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,177.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,81.99,81.99,86.04,14,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,177.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1522,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,171.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,167.87,1522,,facility
HEMOGLOBIN,85018,CPT,305,RC,,,,outpatient,,,113,11.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,2.11,2.11,2.11,20,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,17.92,17.92,72.32,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,3.32,3.32,16.52,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,59.66,14.92,94.03,1 through 10,percent of total billed charges,,,33.6,,14.78,14.78,14.92,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,9.41,9.41,37.97,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,4.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,14,14,14,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,2.11,2.11,2.11,57,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.13,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,2.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,2.37,448,,facility
BENZODIAZEPINES1-12,80346,CPT,301,RC,,,,outpatient,,,324,32.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
PSYCHIATRIC DIAGNOSTIC EVALUATION WITH MEDICAL SERVICES,90792,CPT,0900,RC,,,,outpatient,,,483,48.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,140.97,140.97,169.87,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,169.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,169.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,174.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,293.04,293.04,293.04,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,169.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,355.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,180.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,169.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,180.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1372,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,173.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,169.87,1372,,professional
KNEE JOINT DROP LOCK EA JNT,L2405,HCPCS,274,RC,,,,outpatient,,,161,16.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,66,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,61,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,107.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,107.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,110.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,107.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,225.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,114.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,107.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,114.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,109.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,107.73,225.16,,facility
ROTAVIRUS AG IA,87425,CPT,306,RC,,,,outpatient,,,223,22.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.9,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.98,448,,facility
STUDY OF ESOPHAGUS TO ASSESS MOVEMENT,91010,CPT,0750,RC,,,,outpatient,,,3243,324.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,465.55,465.55,504.72,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,357.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,357.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,367.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,1712.3,1712.3,1712.3,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,1089.65,1089.65,1089.65,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,357.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,746.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,378.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,1621.5,1621.5,1621.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,123.54,123.54,123.54,14,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,357.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,378.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2440,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,364.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,357.13,2440,,facility
HANDLING AND/OR CONVEYANCE OF SPECIMEN FOR TRANSFER TO A LABORATORY,99001,CPT,0300,RC,,,,outpatient,,,119,11.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.71,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,10.71,448,,facility
EMERGENCY DEPARTMENT VISIT FOR LIFE THREATENING OR FUNCTIONING SEVERITY,99285,CPT,0450,RC,,,,outpatient,,,6795,679.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,537.93,503.6,2323.13,245,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3080,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,4139,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1200,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1500,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,569.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,569.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,587.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,4074.08,2397.36,5611.22,1 through 10,percent of total billed charges,,,33.6,,2397.36,2397.36,3879.95,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,2397.36,2397.36,2397.36,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,569.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1191.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,604.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,3567.5,3567.5,3567.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,545.97,245.82,545.97,180,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,569.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,604.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,36.2,,2582.88,1418.03,4195.71,40,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,581.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,4139,,facility
SPECIAL STAINED SPECIMEN SLIDES TO IDENTIFY ORGANISMS INCLUDING INTERPRETATION AND REPORT,88312,CPT,0310,RC,,,,outpatient,,,294,29.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,50.82,50.82,50.82,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,188.16,188.16,1128.96,16,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,173.46,173.46,173.46,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,49.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,49.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,51.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,197.57,197.57,592.7,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,49.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,104.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,52.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,69.57,69.57,72.46,29,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,49.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,52.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,78.23,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,50.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,49.87,448,,facility
REMOVAL OF POLYPS OR GROWTHS OF ESOPHAGUS; STOMACH; AND/OR UPPER SMALL BOWEL USING AN ENDOSCOPE WITH MECHANICAL SNARE,43251,CPT,0750,RC,,,,outpatient,,,7837,783.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,1593.9,1593.9,1593.9,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,1836.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1836.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1891.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,3518.81,3518.81,3518.81,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1836.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3838.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1946.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,0.14,0.14,1689.3,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1836.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1946.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3821,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1873.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3838.31,,facility
GROWTH HORMONE PANEL,80428,CPT,301,RC,,,,outpatient,,,56,5.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,66.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,66.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,68.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,66.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,139.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,70.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,59.33,59.33,59.33,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,66.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,70.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,144.11,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,68.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,66.7,448,,facility
QUANTITATIVE ASSAY DRUG,80299,CPT,301,RC,,,,outpatient,,,442,44.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,13,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,174.64,174.64,174.64,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,171.6,171.6,171.6,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,374.52,374.52,374.52,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.62,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.64,448,,facility
WEST NILE VIRUS ANTIBODY,86789,CPT,302,RC,,,,outpatient,,,50,5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,63.5,63.5,63.5,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,30.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.8,12.8,12.8,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,31.1,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.39,448,,facility
"INJ., APREPITANT, 1 MG",J0185,HCPCS,636,RC,,,,outpatient,,,9,0.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,1.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,617.76,617.76,617.76,260,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,396.63,396.63,396.63,260,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.66,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,1.59,448,,facility
SIMPLE REPAIR OF SURFACE WOUND OF FACE; EARS; EYELIDS; NOSE; LIPS; OR MOUTH; 2.6-5.0 CM,12013,CPT,0450,RC,,,,outpatient,,,1584,158.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,197.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,532.22,532.22,904.46,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,532.22,532.22,532.22,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,401.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,203.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,176.95,176.95,176.95,20,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,203.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,195.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,192.01,448,,facility
UREA NITROGEN LEVEL TO ASSESS KIDNEY FUNCTION; QUANTITATIVE,84520,CPT,0301,RC,,,,outpatient,,,58,5.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.51,3.51,3.51,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,7.9,7.9,7.9,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,37.69,22.18,37.69,1 through 10,percent of total billed charges,,,33.6,,22.18,22.18,22.18,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,22.18,19.49,43.73,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,8.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.51,3.51,3.51,46,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.54,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,4.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,3.95,448,,facility
ASSAY TRIIODOTHYRONINE (T3),84480,CPT,301,RC,,,,outpatient,,,212,21.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.61,12.61,12.61,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,19.85,19.85,19.85,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,12.77,12.77,71.23,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,19.26,12.77,71.23,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,29.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.61,12.61,12.61,15,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.64,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.18,448,,facility
FLUORESCENT ANTIBODY SCREEN,86255,CPT,302,RC,,,,outpatient,,,943,94.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.72,10.72,10.72,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,45.41,28.9,1068.67,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,28.9,28.9,28.9,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.72,10.72,10.72,19,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.04,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.05,448,,facility
UNLISTED MOLECULAR PATHOLOGY,81479,CPT,310,RC,,,,outpatient,,,1525,152.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,561.56,561.56,561.56,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,32.5,32.5,3071.5,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
BILIRUBIN LEVEL; TOTAL,82247,CPT,0301,RC,,,,outpatient,,,376,37.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.47,4.47,4.47,72,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,19.47,19.47,221.84,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,376,376,376,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,214.7,17.42,214.7,80,percent of total billed charges,,,33.6,,126.34,11.09,198.53,22,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,126.34,11.09,127.46,57,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,10.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,16.5,16.5,188,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,6.93,6.93,6.93,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.47,4.47,4.47,682,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.02,448,,facility
ASSAY OF CREATININE,82565,CPT,301,RC,,,,outpatient,,,17,1.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.55,4.55,4.55,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,34.22,10.24,34.22,11,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,30.62,19.49,61.25,61,percent of total billed charges,,,33.6,,19.49,19.49,38.98,20,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,19.49,19.49,38.98,55,percent of total billed charges,,,34.6,,30.62,30.62,30.62,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,10.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,29,29,29,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,12.18,12.18,12.18,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.55,4.55,4.55,281,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.08,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.12,448,,facility
QUANTITATIVE ASSAY DRUG,80299,CPT,301,RC,,,,outpatient,,,206,20.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,13,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,174.64,174.64,174.64,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,171.6,171.6,171.6,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,374.52,374.52,374.52,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.62,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.64,448,,facility
ANALGESICS NON-OPIOID 1 OR 2,80329,CPT,301,RC,,,,outpatient,,,52,5.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
DRUG INFUSION OR EXERCISE FOR HEART STIMULATION DURING DIAGNOSTIC STUDY,93464,CPT,0481,RC,,,,outpatient,,,829,82.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,84.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,84.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,86.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,84.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,175.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,89.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,84.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,89.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2440,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,85.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,84.2,2440,,facility
FIBRIN DEGRADATION QUANT,85379,CPT,305,RC,,,,outpatient,,,128,12.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9.05,9.05,9.05,15,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,20.36,20.36,20.36,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,243.82,143.47,243.82,35,percent of total billed charges,,,33.6,,172.63,67.58,243.82,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,143.47,43.01,144.75,15,percent of total billed charges,,,34.6,,157.99,157.99,157.99,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,21.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,213.5,213.5,213.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,89.67,89.67,89.67,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9.05,9.05,9.05,185,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.98,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,10.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,10.18,448,,facility
EMERGENT INSERTION OF BREATHING TUBE INTO WINDPIPE USING AN ENDOSCOPE,31500,CPT,0450,RC,,,,outpatient,,,1480,148,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,203.75,203.75,209.09,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,226.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,226.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,233.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,226.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,473.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,240.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,222.11,222.11,222.11,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,226.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,240.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,231.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,226.68,1173,,facility
X-RAY OF RIBS ON BOTH SIDES OF BODY; 3 VIEWS,71110,CPT,0320,RC,,,,outpatient,,,1550,155,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,448,,facility
THYROGLOBULIN ANTIBODY,86800,CPT,302,RC,,,,outpatient,,,254,25.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,14.15,14.15,14.15,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,19.47,19.47,92.63,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,17.42,11.09,82.9,1 through 10,percent of total billed charges,,,33.6,,41.02,41.02,52.75,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,41.02,11.09,52.75,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,33.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,14.15,14.15,14.15,30,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,34.37,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,16.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,15.91,448,,facility
REMOVAL OF LOWER PORTION OF LARGE BOWEL TISSUE USING A FLEXIBLE ENDOSCOPE,45349,CPT,0750,RC,,,,outpatient,,,11563,1156.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,2656.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2656.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2736.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2656.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,5552.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2815.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2656.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2815.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3821,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,2709.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,5552.02,,facility
DETECTION TEST BY NUCLEIC ACID FOR HEPATITIS B VIRUS; QUANTIFICATION,87517,CPT,0306,RC,,,,outpatient,,,180,18,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,38.11,38.11,38.11,15,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,44.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,95.04,95.04,355.34,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,60.48,60.48,95.09,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,89.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,45.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,90,90,90,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,38.11,38.11,38.11,25,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,45.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,92.54,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,43.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,42.84,448,,facility
MEASUREMENT OF DNA ANTIBODY; NATIVE OR DOUBLE STRANDED,86225,CPT,0302,RC,,,,outpatient,,,292,29.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.22,12.22,12.22,16,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,32.21,29.57,46.46,11,percent of total billed charges,,,33.6,,29.57,29.57,29.57,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,29.66,29.57,98.11,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,28.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.22,12.22,12.22,49,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.7,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.74,448,,facility
COMPLEMENT ANTIGEN,86160,CPT,302,RC,,,,outpatient,,,74,7.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.67,10.67,10.67,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,87.32,87.32,87.32,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,78.14,49.73,270.86,17,percent of total billed charges,,,33.6,,49.73,49.73,172.37,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,49.73,29.23,50.32,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,256.5,256.5,256.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.67,10.67,10.67,61,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.92,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12,448,,facility
PLATELET ANTIBODIES,86022,CPT,302,RC,,,,outpatient,,,1403,140.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.34,16.34,16.34,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,39.69,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.37,448,,facility
UNLISTED MOLECULAR PATHOLOGY,81479,CPT,310,RC,,,,outpatient,,,45,4.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,561.56,561.56,561.56,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,32.5,32.5,3071.5,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
DETECT AGENT NOS DNA QUANT,87799,CPT,306,RC,,,,outpatient,,,929,92.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,38.11,38.11,38.11,39,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,44.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,200.64,91.44,597.79,1 through 10,percent of total billed charges,,,33.6,,203.95,203.95,203.95,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,231.27,203.95,231.27,11,percent of total billed charges,,,34.6,,220.34,220.34,231.27,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,89.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,45.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,38.11,38.11,38.11,221,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,45.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,92.54,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,43.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,42.84,448,,facility
ASSAY OF PROGESTERONE,84144,CPT,301,RC,,,,outpatient,,,421,42.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,18.55,18.55,18.55,24,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,41.3,41.3,41.3,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,36.96,23.52,222.29,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,23.52,23.52,141.46,29,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,20.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,43.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,18.55,18.55,18.55,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,20.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,45.08,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,21.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,20.86,448,,facility
UPPER EXTREMITY STUDY,93931,CPT,921,RC,,,,outpatient,,,1267,126.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1227,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,1227,,facility
PSYCHOTHERAPY; 45 MINUTES,90834,CPT,0914,RC,,,,outpatient,,,735,73.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,140.97,140.97,152.83,52,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,169.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,169.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,174.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,169.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,355.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,180.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,367.5,367.5,367.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,169.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,180.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,173.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,169.87,448,,professional
RBC LEUKOCYTES REDUCED,P9016,HCPCS,390,RC,,,,outpatient,,,550,55,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,169.72,167.88,335.75,32,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,1502.72,1502.72,1502.72,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,184,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,184,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,189.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,1340.71,1239.74,2479.49,1 through 10,percent of total billed charges,,,33.6,,1239.74,788.93,1340.71,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,795.97,795.97,795.97,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,184,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,384.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,195.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,4930.8,4930.8,4930.8,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,136.54,136.54,273.08,30,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,184,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,195.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,107,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,187.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,107,448,,facility
ASSAY OF FERRITIN,82728,CPT,301,RC,,,,outpatient,,,486,48.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.12,12.12,12.12,348,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,56.64,56.64,185.26,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,50.69,32.26,165.79,96,percent of total billed charges,,,33.6,,32.26,32.26,165.79,18,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,32.26,32.26,105.5,115,percent of total billed charges,,,34.6,,116.18,116.18,116.18,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,28.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,48,48,48,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,65.94,20.16,65.94,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.12,12.12,12.12,882,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.45,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.63,448,,facility
GLUCOSE (SUGAR) LEVEL ON BODY FLUID,82945,CPT,0301,RC,,,,outpatient,,,302,30.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,193.28,193.28,193.28,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,135.6,101.47,159.46,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,8.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,63.42,63.42,63.42,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.5,3.5,3.5,14,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.49,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,4.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,3.93,448,,facility
IMAGING OF DIGESTIVE TRACT DONE FROM THE INSIDE OF THE DIGESTIVE TRACT,91110,CPT,0750,RC,,,,outpatient,,,4571,457.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,868.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,868.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,894.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,868.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1814.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,920.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,474.64,474.64,474.64,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,868.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,920.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3821,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,885.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3821,,facility
VITAMIN K LEVEL,84597,CPT,0301,RC,,,,outpatient,,,644,64.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.2,12.2,12.2,11,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,105.6,105.6,105.6,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,28.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.2,2.11,12.2,20,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.65,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.72,448,,facility
GENE ANALYSIS (MPL PROTO-ONCOGENE; THROMBOPOIETIN RECEPTOR) FOR DETECTION OF COMMON VARIANTS,81338,CPT,0310,RC,,,,outpatient,,,1665,166.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,150.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,150.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,154.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,150.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,314.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,159.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,133.72,133.72,133.72,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,150.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,159.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,263.08,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,153.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,150.33,448,,facility
RETICYTE/HGB CONCENTRATE,85046,CPT,305,RC,,,,outpatient,,,106,10.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,11.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.04,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.57,448,,facility
MEASUREMENT OF HEPATITIS A ANTIBODY,86708,CPT,0302,RC,,,,outpatient,,,119,11.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.02,11.02,11.02,30,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,76.16,76.16,76.16,24,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,70.21,70.21,70.21,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,62.83,39.98,62.83,12,percent of total billed charges,,,33.6,,39.98,39.98,62.83,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,39.98,39.98,201.6,23,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,59.5,59.5,59.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.02,11.02,11.02,102,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.76,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.39,448,,facility
DETECT AGENT NOS DNA QUANT,87799,CPT,306,RC,,,,outpatient,,,360,36,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,38.11,38.11,38.11,39,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,44.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,200.64,91.44,597.79,1 through 10,percent of total billed charges,,,33.6,,203.95,203.95,203.95,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,231.27,203.95,231.27,11,percent of total billed charges,,,34.6,,220.34,220.34,231.27,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,89.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,45.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,38.11,38.11,38.11,221,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,45.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,92.54,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,43.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,42.84,448,,facility
"INJECTION, PERTUZUMAB, 1 MG",J9306,HCPCS,636,RC,,,,outpatient,,,57,5.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,14124.6,14124.6,14124.6,420,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,17.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,12640.32,12640.32,12640.32,840,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,8115.66,8115.66,8115.66,420,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,35.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,34.81,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.2,448,,facility
SOMATOSTATIN (GROWTH HORMONE INHIBITOR) LEVEL,84307,CPT,0301,RC,,,,outpatient,,,356,35.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,39.48,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.28,448,,facility
ASSAY OF URINE/UREA-N,84540,CPT,301,RC,,,,outpatient,,,88,8.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,91.87,91.87,91.87,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,11.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,135.5,135.5,135.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.95,4.95,4.95,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.26,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.56,448,,facility
SINGLE CONTRAST X-RAY OF SMALL INTESTINE,74250,CPT,0320,RC,,,,outpatient,,,2155,215.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,1379.2,1379.2,1379.2,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,1271.45,1271.45,1271.45,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,172.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,350.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,177.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,66.36,66.36,66.36,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,177.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,171.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,167.87,448,,facility
CT ANGIO LWR EXTR W/O&W/DYE,73706,CPT,352,RC,,,,outpatient,,,6927,692.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,875,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1050,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,172.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,350.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,177.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,143,143,143,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,177.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1522,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,171.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,167.87,1522,,facility
ADMINISTRATION OF CHEMOTHERAPY INTO GROWTH; 1-7,96405,CPT,0331,RC,,,,outpatient,,,200,20,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,68.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,68.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,70.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,68.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,144.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,73.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,63.38,63.38,63.38,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,68.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,73.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1603,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,70.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,68.91,1603,,facility
ELECTRONIC ANALYSIS OF IMPLANTED BRAIN; SPINAL CORD; OR PERIPHERAL NEUROSTIMULATOR GENERATOR WITH BRAIN STIMULATOR PROGRAMMING; FIRST 15 MINUTES WITH QUALIFIED HEALTH PROFESSIONAL,95983,CPT,0920,RC,,,,outpatient,,,332,33.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,80.53,80.53,83.93,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,90.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,90.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,93.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,90.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,190.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,96.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,41.94,41.94,43.42,14,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,90.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,96.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,422,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,92.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,90.99,448,,facility
X-RAY OF RIBS ON SIDE OF BODY; MINIMUM OF 3 VIEWS,71101,CPT,0320,RC,,,,outpatient,,,1292,129.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,23.72,23.72,23.72,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,448,,facility
NUCLEAR ANTIGEN ANTIBODY,86235,CPT,302,RC,,,,outpatient,,,281,28.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13,12.5,15.95,11,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,54.91,4.37,90.29,43,percent of total billed charges,,,33.6,,4.37,4.37,53.09,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,22.18,4.24,83.33,13,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,37.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.95,13,15.95,54,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.75,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.93,448,,facility
SPECTROPHOTOMETRY,84311,CPT,301,RC,,,,outpatient,,,115,11.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,7.2,7.2,7.2,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,45.35,45.35,53.33,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,16.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,7.2,7.2,7.2,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.1,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,8.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,8.1,448,,facility
ENDO AK/HIP KNEE EXTENS ASSI,L5850,HCPCS,274,RC,,,,outpatient,,,312,31.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,66,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,61,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,208.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,208.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,215.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,208.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,436.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,221.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,208.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,221.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,212.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,208.81,436.41,,facility
CRYPTOCOCCUS ANTIBODY,86641,CPT,302,RC,,,,outpatient,,,79,7.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,30.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,31.13,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.41,448,,facility
CMV ANTIBODY IGM,86645,CPT,302,RC,,,,outpatient,,,221,22.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,14.99,14.99,14.99,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,27.52,27.52,27.52,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,163.38,163.38,163.38,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,19.83,19.82,19.83,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,35.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,14.99,0.22,14.99,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.4,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,16.85,448,,facility
ALCOHOLS LEVELS; 1 OR 2,80321,CPT,0301,RC,,,,outpatient,,,110,11,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
SIMPLE DRAINAGE OF CYST OF TAILBONE,10080,CPT,0450,RC,,,,outpatient,,,798,79.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,617.33,577.94,626.56,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,677.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,677.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,698.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,677.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1416.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,718.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,626.56,626.56,626.56,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,677.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,718.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,691.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1416.43,,facility
OTHER PROCEDURE ON MALE GENITAL SYSTEM,55899,CPT,0450,RC,,,,outpatient,,,798,79.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,239.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,239.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,246.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,239.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,499.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,253.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,239.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,253.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,243.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,239.12,1311,,facility
ENCEPHALTIS WEST EQNE ANTBDY,86654,CPT,302,RC,,,,outpatient,,,70,7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.49,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.19,448,,facility
CT SCAN OF CRANIAL CAVITY WITH CONTRAST,70481,CPT,0351,RC,,,,outpatient,,,7528,752.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,156.2,154.84,167.87,12,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,403,,,,,,,case rate,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,371,,,,,,,case rate,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,875,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1050,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,172.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,4298.49,4298.49,4298.49,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,2529.41,2529.41,2529.41,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,350.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,177.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,105.19,105.19,110.2,12,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,177.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1522,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,171.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,167.87,1522,,facility
REMOVAL AND MICROSCOPIC EXAM OF GROWTH OF TRUNK; ARMS; OR LEGS; 1-5 TISSUE BLOCKS,17313,CPT,0761,RC,,,,outpatient,,,3201,320.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,537.09,537.09,707.34,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,707.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,707.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,728.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,707.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1478.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,749.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.28,10.28,10.28,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,707.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,749.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,721.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1478.34,,facility
AMPLIFED DNA PROBE DETECTION OF 20 GRAM-POSITIVE BACTERIAL TARGETS; 6 RESISTANCE GENES; 1 PAN GRAM-NEGATIVE BACTERIAL TARGET; AND 1 PAN CANDIDA TARGET IN BLOOD CULTURE SPECIMEN,0142U,CPT,0300,RC,,,,outpatient,,,533,53.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,156.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,156.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,161.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,156.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,327.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,166.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,156.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,166.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,274.31,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,159.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,156.75,448,,facility
SPECIAL FLUORESCENT AND/OR ACID FAST STAIN FOR MICROORGANISM,87206,CPT,0306,RC,,,,outpatient,,,65,6.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.79,4.79,4.79,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,11.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.79,4.79,4.79,21,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.64,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.39,448,,facility
DIALYSIS PROCEDURE INCLUDING 1 EVALUATION,90945,CPT,0841,RC,,,,outpatient,,,2198,219.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,399.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,399.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,411.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,399.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,834.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,423.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,399.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,423.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2057,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,407.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,399.34,2057,,facility
MEASUREMENT OF INFLIXIMAB,80230,CPT,0301,RC,,,,outpatient,,,944,94.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,39.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,38.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,80.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,40.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,38.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,40.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,67.5,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,39.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,38.57,448,,facility
WHOLE MITOCHONDRIAL GENOME,81460,CPT,310,RC,,,,outpatient,,,1400,140,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1287,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1287,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1325.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1287,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,2689.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1364.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1287,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1364.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2252.25,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1312.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,2689.83,,facility
AFO PLASTIC,L1930,HCPCS,274,RC,,,,outpatient,,,539,53.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,66,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,61,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,362.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,362.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,373.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,362.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,757.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,384.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,362.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,384.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,369.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,362.45,757.52,,facility
NERVE CONDUCTION; 3-4 STUDIES,95908,CPT,0922,RC,,,,outpatient,,,943,94.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,206.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,206.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,212.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,206.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,431.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,219.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,206.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,219.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,478,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,210.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,206.65,478,,facility
DRUG ASSAY ADALIMUMAB,80145,CPT,301,RC,,,,outpatient,,,602,60.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,39.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,38.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,80.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,40.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,34.31,34.31,34.31,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,38.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,40.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,67.5,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,39.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,38.57,448,,facility
3D RADIOGRAPHIC PROCEDURE WITH COMPUTERIZED IMAGE POSTPROCESSING,76377,CPT,0350,RC,,,,outpatient,,,2654,265.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,403,,,,,,,case rate,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,371,,,,,,,case rate,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,875,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1050,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,1401.31,1401.31,1401.31,1 through 10,percent of total billed charges,,,33.6,,1092.43,1092.43,1092.43,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,74.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1522,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,36.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.67,1522,,facility
INSERTION OF TUBE IN LEFT LOWER HEART CHAMBER AND CORONARY ARTERY FOR DIAGNOSIS WITH REVIEW BY RADIOLOGIST,93458,CPT,0480,RC,,,,outpatient,,,23698,2369.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,2822.09,2822.09,5002.54,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,2004,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,2759,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 6500.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 10000.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,3102.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3102.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3195.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3102.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,6484.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3288.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,615.54,571.69,2919.38,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3102.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3288.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1463,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,3164.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,1463,6484.66,,facility
URINE PREGNANCY TEST,81025,CPT,307,RC,,,,outpatient,,,27,2.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,7.66,7.66,7.66,156,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,68.48,17.28,107,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,48.04,35.95,61.1,142,percent of total billed charges,,,33.6,,35.95,35.95,61.1,24,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,35.95,27.8,35.95,71,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,17.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,9.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,53.5,41,53.5,18,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,22.47,22.47,22.47,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,7.66,7.66,7.66,1310,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,9.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.07,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,8.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,8.61,448,,facility
IRRIGATION AND SUCTION OF LUNG AIRWAYS TO OBTAIN CELLS USING AN ENDOSCOPE,31624,CPT,0750,RC,,,,outpatient,,,7194,719.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,1513.06,1478.43,1602.81,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,1703.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1703.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1754.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1703.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3560.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1805.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,1535.67,1535.67,1602.81,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1703.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1805.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3821,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1737.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3821,,facility
BACTERIAL COLONY COUNT; URINE,87086,CPT,0306,RC,,,,outpatient,,,79,7.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,7.18,7.18,7.18,21,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,65.92,35.84,65.92,12,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,46.61,33.04,143.37,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,54.38,34.61,58.81,1 through 10,percent of total billed charges,,,33.6,,32.04,32.04,34.61,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,34.61,18.82,34.61,12,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,16.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,51.5,51.5,51.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,21.63,21.63,21.63,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,7.18,7.18,7.18,106,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.43,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,8.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,8.07,448,,facility
AMBULATORY SURGICAL BOOT EAC,L3260,HCPCS,274,RC,,,,outpatient,,,54,5.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,66,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,61,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,facility
SOFT INTERFACE BELOW KNEE SE,L2820,HCPCS,274,RC,,,,outpatient,,,150,15,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,66,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,61,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,99.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,99.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,102.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,99.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,208.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,105.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,99.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,105.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,101.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,99.79,208.56,,facility
GONADOTROPIN; CHORIONIC (REPRODUCTIVE HORMONE) LEVEL,84702,CPT,0301,RC,,,,outpatient,,,191,19.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.39,13.39,13.39,99,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,35.99,35.99,146.32,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,32.21,32.21,141.61,16,percent of total billed charges,,,33.6,,32.21,20.5,83.33,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,20.5,20.5,83.33,45,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,31.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,12.81,12.81,12.81,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,13.39,13.39,13.39,1 through 10,percent of total billed charges,,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.39,13.39,13.39,208,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.53,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,15.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,15.05,448,,facility
MRI SCAN OF CHEST WITHOUT CONTRAST,71550,CPT,0610,RC,,,,outpatient,,,7408,740.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,786,,,,,,,case rate,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,728,,,,,,,case rate,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1025,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1350,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,235.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,477.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,242.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,242.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2407,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,232.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,228.36,2407,,facility
FLUORESCENT ANTIBODY SCREEN,86255,CPT,302,RC,,,,outpatient,,,488,48.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.72,10.72,10.72,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,45.41,28.9,1068.67,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,28.9,28.9,28.9,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.72,10.72,10.72,19,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.04,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.05,448,,facility
MOLECULAR PATHOLOGY PROCEDURE LEVEL 5,81404,CPT,0310,RC,,,,outpatient,,,2993,299.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,274.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,274.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,283.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,274.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,574.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,291.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,274.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,291.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,480.95,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,280.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,274.83,574.39,,facility
REPAIR OF SEPARATION OF WOUND CLOSURE WITH INSERTION OF PACKING,12021,CPT,0761,RC,,,,outpatient,,,798,79.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,350.55,350.55,350.55,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,400.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,813.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,412.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,412.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,396.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,389.05,1173,,facility
MOPATH PROCEDURE LEVEL 5,81404,CPT,310,RC,,,,outpatient,,,542,54.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,274.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,274.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,283.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,274.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,574.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,291.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,274.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,291.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,480.95,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,280.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,274.83,574.39,,facility
EVALUATION OF CARDIAC RHYTHM MONITOR SYSTEM; REMOTE UP TO 30 DAYS,93298,CPT,0480,RC,,,,outpatient,,,143,14.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,32.72,32.72,35.47,113,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,91.52,91.52,91.52,25,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,84.37,84.37,84.37,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,35.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,75.5,48.05,75.5,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,48.05,48.05,48.05,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,74.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,61.75,61.75,64.38,139,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1463,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,36.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.71,1463,,facility
X-RAY EXAM OF ELBOW,73070,CPT,320,RC,,,,outpatient,,,1636,163.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,85.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,174.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,17.25,17.25,17.75,92,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,84.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,83.29,448,,facility
FLUORESCENT ANTIBODY SCREEN,86255,CPT,302,RC,,,,outpatient,,,1671,167.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.72,10.72,10.72,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,45.41,28.9,1068.67,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,28.9,28.9,28.9,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.72,10.72,10.72,19,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.04,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.05,448,,facility
ENDOSKELETAL AXIAL ROTATION,L5984,HCPCS,274,RC,,,,outpatient,,,1223,122.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,66,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,61,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,823.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,823.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,847.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,823.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1720.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,872.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,823.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,872.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,839.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,823.06,1720.2,,facility
COLLAGEN DRESSING >48 SQ IN,A6023,HCPCS,272,RC,,,,outpatient,,,435,43.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",448,448,,facility
HEAVY METAL QUAN EACH NES,83018,CPT,301,RC,,,,outpatient,,,88,8.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,21.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,45.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,23.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,21.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,23.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,47.46,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,22.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,21.96,448,,facility
SEMEN ANALYSIS FOR SPERM PRESENCE,89321,CPT,0300,RC,,,,outpatient,,,52,5.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,17.47,17.47,17.47,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.04,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.05,448,,facility
ASSAY OF PROINSULIN,84206,CPT,301,RC,,,,outpatient,,,87,8.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,26.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,55.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,28.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,26.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,28.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,46.71,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,27.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,26.69,448,,facility
STATIC OR DYNAMI AFO PRE OTS,L4397,HCPCS,274,RC,,,,outpatient,,,405,40.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,66,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,61,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,207.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,207.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,213.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,207.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,433.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,219.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,207.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,219.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,211.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,207.4,433.47,,facility
ASSAY OF URINE CREATININE,82570,CPT,301,RC,,,,outpatient,,,93,9.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.61,4.61,4.61,213,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,71.39,41.89,142.78,14,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,37.49,23.86,74.98,60,percent of total billed charges,,,33.6,,37.49,23.85,81.31,18,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,24.07,23.86,47.71,75,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,10.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,60.5,4.61,151,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,14.91,14.91,25.41,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,85.58,85.58,85.58,1 through 10,percent of total billed charges,,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.61,4.61,4.61,636,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.18,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.18,448,,facility
DXA BONE DENSITY MEASUREMENT OF HIP; PELVIS; SPINE,77080,CPT,0320,RC,,,,outpatient,,,346,34.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,39.86,39.86,39.86,32,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,39.86,39.86,39.86,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,151.2,57.61,237.6,26,percent of total billed charges,,,33.6,,57.61,57.61,57.61,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,117.29,57.61,151.2,15,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,448,,facility
TEST TO MEASURE OXYGEN LEVEL IN BLOOD USING EAR OR FINGER DEVICE,94760,CPT,0460,RC,,,,outpatient,,,128,12.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,611,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",448,611,,facility
SYMES TYPE POSTER OPENING SO,L5634,HCPCS,274,RC,,,,outpatient,,,549,54.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,66,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,61,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,372.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,372.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,383.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,372.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,778.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,394.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,372.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,394.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,379.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,372.4,778.32,,facility
NOS EACH ORGANISM AG IA,87449,CPT,306,RC,,,,outpatient,,,799,79.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,198,198,198,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,26.27,26.27,26.27,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.66,10.66,10.66,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.9,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.98,448,,facility
INTERMEDIATE PROTON BEAM RADIATION TREATMENT,77523,CPT,0333,RC,,,,outpatient,,,5332,533.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,1125.4,1047.72,1135.86,35,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2564,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1196.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1196.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1231.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,2060.35,2060.35,2060.35,29,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1196.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,2499.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1267.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,1135.86,1125.4,1135.86,76,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1196.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1267.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,48815,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1219.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,48815,,facility
EHRLICHIA ANTIBODY,86666,CPT,302,RC,,,,outpatient,,,274,27.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,7.53,7.53,7.53,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,21.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9.05,9.05,9.05,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.98,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,10.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,10.18,448,,facility
PHOSPHATASE (ENZYME) LEVEL; ALKALINE,84075,CPT,0301,RC,,,,outpatient,,,81,8.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.61,4.61,4.61,50,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,15.34,10.36,15.34,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,81,81,81,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,46.25,13.73,46.25,76,percent of total billed charges,,,33.6,,27.22,8.74,46.25,18,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,27.22,8.74,27.46,55,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,10.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,40.5,13,40.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,5.46,5.46,5.46,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.61,4.61,4.61,627,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.18,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.18,448,,facility
HEPARIN ASSAY,85520,CPT,0305,RC,,,,outpatient,,,392,39.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.64,11.64,11.64,13,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,131.71,49.68,223.83,17,percent of total billed charges,,,33.6,,131.71,131.71,131.71,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,131.76,131.71,132.89,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,196,196,196,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,82.32,82.32,82.32,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.64,11.64,11.64,91,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.28,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.09,448,,facility
HIGH PRECISION RADIATION THERAPY PLANNING,77301,CPT,0333,RC,,,,outpatient,,,10367,1036.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,7902.72,6634.88,7902.72,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,7285.32,7285.32,7285.32,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1324.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1324.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1364.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,5473.78,4148.93,6519.74,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,4148.93,4148.93,4148.93,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1324.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,2768.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1404.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,6174,5183.5,6174,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,1155.99,1155.99,1155.99,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1324.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1404.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,48815,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1351.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,48815,,facility
IGG 1 2 3 OR 4 EACH,82787,CPT,301,RC,,,,outpatient,,,30,3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,52.8,13.2,263.18,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,33.9,33.9,33.9,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,16.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.33,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,8.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,8.02,448,,facility
PROTEIN WESTERN BLOT TEST,84182,CPT,301,RC,,,,outpatient,,,280,28,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,217.54,217.54,217.54,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,29.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,61.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,30.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,25.98,25.98,25.98,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,29.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,30.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,51.12,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,29.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,29.21,448,,facility
NEEDLE BIOPSY OF GROWTH OF ABDOMINAL CAVITY,49180,CPT,0361,RC,,,,outpatient,,,1772,177.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,1421.6,1421.6,1421.6,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1628.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,657.89,657.89,657.89,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3303.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1675.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1675.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3821,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1612.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3821,,facility
FLEX FOOT SYSTEM,L5980,HCPCS,274,RC,,,,outpatient,,,7121,712.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,66,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,61,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Stoploss First Dollar + Reimbursement Rate 50.00 + Percent Of Charge + Reimbursement Rate 0.00 + Fixed Amount 3149.00,,,,0,other,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,Stoploss First Dollar + Reimbursement Rate 50.00 + Percent Of Charge + Reimbursement Rate 0.00 + Fixed Amount 3149.00,,,,0,other,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,4801.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4801.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4945.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4801.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,10034.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5089.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4801.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5089.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,4897.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,4801.22,10034.55,,facility
NOS EACH ORGANISM AG IA,87449,CPT,306,RC,,,,outpatient,,,761,76.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,198,198,198,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,26.27,26.27,26.27,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.66,10.66,10.66,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.9,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.98,448,,facility
ALPHA-FETOPROTEIN (AFP) ANALYSIS,82107,CPT,0301,RC,,,,outpatient,,,542,54.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,57.29,57.29,57.29,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,64.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,64.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,66.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,328.94,328.94,328.94,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,209.33,209.33,209.33,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,64.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,134.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,68.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,57.29,57.29,57.29,11,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,64.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,68.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,139.16,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,65.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,64.41,448,,facility
COCCIDIOIDES ANTIBODY,86635,CPT,302,RC,,,,outpatient,,,260,26,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,107.18,107.18,107.18,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,23.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.2,10.2,10.2,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.8,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,11.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.47,448,,facility
MEASUREMENT OF TISSUE TRANSGLUTAMINASE,86364,CPT,0302,RC,,,,outpatient,,,9,0.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9,9,10.26,36,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,10.62,10.62,55.46,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,9.5,6.1,38.02,36,percent of total billed charges,,,33.6,,6.05,6.05,6.05,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,6.05,6.05,6.1,19,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,24.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,9,9,9,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9,9,10.26,141,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.18,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,11.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.53,448,,facility
EXTRACRANIAL BILAT STUDY,93880,CPT,921,RC,,,,outpatient,,,4642,464.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,235.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,477.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,242.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,242.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1227,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,232.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,228.36,1227,,facility
REFILLING AND MAINTENANCE OF PORTABLE PUMP,96521,CPT,0260,RC,,,,outpatient,,,478,47.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,173.06,173.06,184.86,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,203.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,203.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,209.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,160.61,160.61,160.61,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,203.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,425.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,215.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,203.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,215.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,427,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,207.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,203.57,448,,facility
DRUG TEST PRSMV CHEM ANLYZR,80307,CPT,301,RC,,,,outpatient,,,1120,112,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,55.27,55.27,55.27,34,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,62.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,62.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,171.87,131.38,223.26,14,percent of total billed charges,,,33.6,,206.45,131.38,223.26,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,131.38,102.04,131.38,13,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,62.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,129.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,65.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,55.27,55.27,55.27,332,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,62.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,65.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,125.7,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,63.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,62.14,448,,facility
ENZYME CELL ACTIVITY,82657,CPT,301,RC,,,,outpatient,,,462,46.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.72,19.72,19.72,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,2094.14,2094.14,2094.14,1 through 10,percent of total billed charges,,,33.6,,762.96,762.96,762.96,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,46.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,23.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.72,19.72,19.72,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,23.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,39.01,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,22.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,22.17,448,,facility
CLOTTING FACTOR VIII (VW FACTOR) ANTIGEN,85246,CPT,0305,RC,,,,outpatient,,,135,13.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,20.4,20.4,20.4,44,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,23.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,71.28,45.36,71.28,1 through 10,percent of total billed charges,,,33.6,,45.36,45.36,45.36,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,45.77,45.36,45.77,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,47.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,24.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,67.5,67.5,67.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,20.4,20.4,20.4,74,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,24.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,49.56,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,23.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,22.94,448,,facility
ASSAY OF TOTAL TESTOSTERONE,84403,CPT,301,RC,,,,outpatient,,,76,7.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,22.96,20,22.96,75,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,44.84,11.8,294.41,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,35.9,10.56,263.47,33,percent of total billed charges,,,33.6,,40.13,25.54,169.16,16,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,25.54,6.72,167.66,56,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,25.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,53.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,27.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,38,38,38,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,4.2,4.2,4.2,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,22.96,20,22.96,116,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,25.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,27.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,55.77,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,26.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,25.81,448,,facility
DRUG SCREENING TRAMADOL,80373,CPT,301,RC,,,,outpatient,,,222,22.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
UNLISTED MOLECULAR PATHOLOGY,81479,CPT,310,RC,,,,outpatient,,,3000,300,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,561.56,561.56,561.56,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,32.5,32.5,3071.5,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
MICRODISSECTION MANUAL,88381,CPT,310,RC,,,,outpatient,,,225,22.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,93.74,93.74,93.74,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,21.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,44.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,21.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,172.62,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,21.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,21.51,448,,facility
NFCT AGT GNTYP ALYS HIV1,87906,CPT,306,RC,,,,outpatient,,,205,20.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,120.95,120.95,120.95,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,128.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,128.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,132.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,108.24,108.24,108.24,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,128.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,269.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,136.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,114.5,114.5,114.5,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,128.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,136.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,278.11,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,131.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,128.73,448,,facility
MYCOPHENOLATE (MYCOPHENOLIC ACID) LEVEL,80180,CPT,0301,RC,,,,outpatient,,,331,33.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,37.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.06,16.06,16.06,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.99,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.05,448,,facility
HSV DNA AMP PROBE,87529,CPT,306,RC,,,,outpatient,,,115,11.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,244.61,244.61,244.61,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
CT SCAN OF ARM WITH CONTRAST,73201,CPT,0352,RC,,,,outpatient,,,3562,356.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,403,,,,,,,case rate,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,371,,,,,,,case rate,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,875,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1050,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,333.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,333.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,343.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,333.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,697.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,353.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,126.31,126.31,126.31,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,333.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,353.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1522,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,340.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,333.9,1522,,facility
REMOVAL OF LARGE BOWEL TISSUE USING A FLEXIBLE ENDOSCOPE,45390,CPT,0750,RC,,,,outpatient,,,11563,1156.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,2656.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2656.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2736.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,3946.32,3946.32,3946.32,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2656.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,5552.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2815.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,282.71,282.71,282.71,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2656.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2815.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3821,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,2709.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,5552.02,,facility
SMEAR FLUORESCENT/ACID STAI,87206,CPT,306,RC,,,,outpatient,,,25,2.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.79,4.79,4.79,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,11.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.79,4.79,4.79,21,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.64,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.39,448,,facility
AUTOMATED PLATELET COUNT,85049,CPT,305,RC,,,,outpatient,,,272,27.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,9.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.98,3.98,3.98,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.68,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,4.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,4.48,448,,facility
WHOLE MITOCHONDRIAL GENOME,81460,CPT,310,RC,,,,outpatient,,,400,40,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1287,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1287,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1325.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1287,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,2689.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1364.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1287,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1364.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2252.25,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1312.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,2689.83,,facility
ASSAY OF GGT,82977,CPT,301,RC,,,,outpatient,,,69,6.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,6.4,6.4,6.4,117,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,231.28,231.28,231.28,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,223.83,36.43,223.83,54,percent of total billed charges,,,33.6,,131.71,23.18,206.98,13,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,23.39,23.18,132.89,33,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,6.4,6.4,6.4,1 through 10,percent of total billed charges,,7.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,15.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,7.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,196,34.5,196,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,6.4,6.4,6.4,714,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,7.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,7.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.56,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,7.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,7.2,448,,facility
INSULIN MEASUREMENT; FREE,83527,CPT,0301,RC,,,,outpatient,,,92,9.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,35.62,35.62,35.62,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.97,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.95,448,,facility
ASSAY OF CALCIUM,82330,CPT,301,RC,,,,outpatient,,,54,5.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.17,12.17,12.17,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,85.31,18.14,138.18,19,percent of total billed charges,,,33.6,,81.31,81.31,81.31,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,64.41,18.14,81.31,24,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,28.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,50.82,50.82,50.82,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.17,12.17,12.17,185,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.54,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.68,448,,facility
PSYCHIATRIC DIAGNOSTIC EVALUATION,90791,CPT,0900,RC,,,,outpatient,,,483,48.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,140.97,140.97,169.87,145,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,169.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,169.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,174.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,169.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,355.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,180.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.56,11.56,11.56,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,169.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,180.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1372,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,173.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,169.87,1372,,professional
MOPATH PROCEDURE LEVEL 7,81406,CPT,310,RC,,,,outpatient,,,7150,715,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,282.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,282.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,291.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,282.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,591.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,299.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,282.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,299.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,495.04,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,288.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,282.88,591.22,,facility
IMMUNOASSAY QUANT NOS NONAB,83520,CPT,301,RC,,,,outpatient,,,57,5.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,36,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,66.08,66.08,66.08,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,41.18,24.82,318.38,1 through 10,percent of total billed charges,,,33.6,,37.63,37.63,96.43,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,33.6,23.18,176.4,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,36.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,87,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.22,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.27,448,,facility
ALLG SPEC IGE RECOMB EA,86008,CPT,302,RC,,,,outpatient,,,103,10.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,37.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.75,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.93,448,,facility
AFO SUPRAMALLEOLAR CUSTOM,L1907,HCPCS,274,RC,,,,outpatient,,,1033,103.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,66,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,61,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,695.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,695.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,716.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,695.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1452.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,736.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,695.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,736.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,709.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,695.21,1452.99,,facility
INJ LUSPATERCEPT-AAMT 0.25MG,J0896,HCPCS,636,RC,,,,outpatient,,,160,16,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,43.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,43.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,44.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,43.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,90.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,46.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,43.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,46.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,88.75,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,44.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,43.51,448,,facility
IMMUNOASSAY NONANTIBODY,83516,CPT,301,RC,,,,outpatient,,,280,28,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9,9,10.26,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,4.75,4.75,218.59,30,percent of total billed charges,,,33.6,,3.02,3.02,175.39,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,3.02,3.02,211.68,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,24.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,23.5,23.5,23.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9,9,10.26,51,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.92,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,11.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.53,448,,facility
FLUORESCENT ANTIBODY SCREEN,86255,CPT,302,RC,,,,outpatient,,,1396,139.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.72,10.72,10.72,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,45.41,28.9,1068.67,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,28.9,28.9,28.9,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.72,10.72,10.72,19,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.04,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.05,448,,facility
ASSAY OF ALDOLASE,82085,CPT,301,RC,,,,outpatient,,,365,36.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,8.64,8.64,8.64,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,40.13,40.13,40.26,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,25.54,25.54,33.6,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,9.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,20.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,8.64,8.64,8.64,15,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,9.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.98,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,9.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,9.71,448,,facility
KNEE-SHIN EXO VARIABLE FRICT,L5714,HCPCS,274,RC,,,,outpatient,,,866,86.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,66,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,61,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,587.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,587.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,605.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,587.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1228.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,622.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,587.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,622.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,599.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,587.64,1228.17,,facility
INFUSION INTO A VEIN FOR HYDRATION; EACH ADDITIONAL HOUR,96361,CPT,0456,RC,,,,outpatient,,,286,28.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,40.48,37.9,40.48,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,44.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,44.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,46.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,44.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,93.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,47.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,41.09,41.09,41.09,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,44.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,47.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,405,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,45.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,44.82,448,,facility
TRICHOMONAS VAGINALIS AMPLIF,87661,CPT,306,RC,,,,outpatient,,,415,41.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,57,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,127.44,127.44,127.44,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,114.05,72.58,123.34,1 through 10,percent of total billed charges,,,33.6,,28.9,28.9,114.05,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,72.58,28.9,73.22,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,91,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
X-RAY OF HEEL; MINIMUM OF 2 VIEWS,73650,CPT,0320,RC,,,,outpatient,,,901,90.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,85.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,174.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,84.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,83.29,448,,facility
ANTINUCLEAR ANTIBODIES,86038,CPT,302,RC,,,,outpatient,,,55,5.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.75,10.75,10.75,34,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,148.09,148.09,148.09,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,84.34,29.04,132.53,14,percent of total billed charges,,,33.6,,84.34,18.48,127.78,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,84.34,84.34,85.09,12,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,11.55,11.55,11.55,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.75,10.75,10.75,126,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.11,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.09,448,,facility
ANDROSTENEDIONE (HORMONE) LEVEL,82157,CPT,0301,RC,,,,outpatient,,,88.8,8.88,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,26.04,26.04,26.04,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,29.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,61.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,31.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,26.04,0.22,26.04,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,29.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,31.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,63.25,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,29.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,29.28,448,,facility
CABAZITAXEL INJECTION,J9043,HCPCS,636,RC,,,,outpatient,,,730,73,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,233.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,233.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,240.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,233.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,488.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,247.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,233.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,247.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,481.79,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,238.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,233.73,488.5,,facility
COMPLEMENT ANTIGEN,86160,CPT,302,RC,,,,outpatient,,,261,26.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.67,10.67,10.67,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,87.32,87.32,87.32,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,78.14,49.73,270.86,17,percent of total billed charges,,,33.6,,49.73,49.73,172.37,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,49.73,29.23,50.32,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,256.5,256.5,256.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.67,10.67,10.67,61,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.92,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12,448,,facility
IMMUNOASSAY INFECTIOUS AGENT,86317,CPT,302,RC,,,,outpatient,,,260,26,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.33,13.33,13.33,86,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,59,59,59,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,52.8,26.54,52.8,41,percent of total billed charges,,,33.6,,52.8,33.6,52.8,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,33.6,33.6,33.73,52,percent of total billed charges,,,34.6,,218.53,218.53,218.53,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,31.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,50,50,50,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.33,13.33,13.33,209,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.38,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,15.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.99,448,,facility
ASSAY OF BLOOD/URIC ACID,84550,CPT,301,RC,,,,outpatient,,,40,4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.02,4.02,4.02,51,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,23.6,23.6,23.6,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,75.26,21.12,118.27,23,percent of total billed charges,,,33.6,,75.26,75.26,75.26,42,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,75.26,13.44,85.34,40,percent of total billed charges,,,34.6,,81.31,81.31,85.34,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,9.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,47.04,47.04,47.04,18,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.02,4.02,4.02,166,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.77,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,4.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,4.52,448,,facility
SIMPLE DRAINAGE OF ABSCESS OF FINGER,26010,CPT,0450,RC,,,,outpatient,,,1742,174.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,174.34,174.34,174.34,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,197.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,401.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,203.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,203.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,195.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,192.01,448,,facility
DRUG TEST PRSMV CHEM ANLYZR,80307,CPT,301,RC,,,,outpatient,,,958,95.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,55.27,55.27,55.27,34,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,62.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,62.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,171.87,131.38,223.26,14,percent of total billed charges,,,33.6,,206.45,131.38,223.26,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,131.38,102.04,131.38,13,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,62.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,129.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,65.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,55.27,55.27,55.27,332,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,62.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,65.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,125.7,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,63.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,62.14,448,,facility
FLOW CYTOMETRY DETECTION OF AQUAPORIN-4 (NEUROMYELITIS OPTICA [NMO]) ANTIBODY,86053,CPT,0302,RC,,,,outpatient,,,1300,130,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,33.56,33.56,33.56,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,37.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,37.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,436.8,436.8,686.4,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,440.7,440.7,440.7,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,78.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,39.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,33.56,33.56,33.56,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,39.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.09,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,38.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,21.09,448,,facility
MICRODISSECTION MANUAL,88381,CPT,310,RC,,,,outpatient,,,236,23.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,93.74,93.74,93.74,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,21.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,44.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,21.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,172.62,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,21.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,21.51,448,,facility
FIBRINOGEN ACTIVITY,85384,CPT,305,RC,,,,outpatient,,,27,2.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,8.65,8.65,8.65,24,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,35.38,22.51,262.09,12,percent of total billed charges,,,33.6,,35.38,22.51,154.22,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,154.22,154.22,311.2,1 through 10,percent of total billed charges,,,34.6,,169.83,169.83,169.83,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,9.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,20.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,33.5,33.5,33.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,8.65,8.65,8.65,96,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,9.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.36,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,9.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,9.72,448,,facility
UNLISTED MOLECULAR PATHOLOGY,81479,CPT,310,RC,,,,outpatient,,,2194,219.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,561.56,561.56,561.56,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,32.5,32.5,3071.5,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
TEST FOR TONE AND SENSATION OF RECTUM AND ANUS,91120,CPT,0750,RC,,,,outpatient,,,570,57,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 103.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment.",,,,0,other,"Payer contract is 103.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment. + No services performed during 15-month lookback period",,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment. + No services performed during 15-month lookback period",,,"Payer contract is 209.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment.",,,,0,other,"Payer contract is 209.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment. + No services performed during 15-month lookback period",,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment. + No services performed during 15-month lookback period",,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,348.08,348.08,377.09,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2440,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,"Payer contract is 102.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment.",302.13,302.13,302.13,1 through 10,other,"Payer contract is 102.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment.",448,2440,,facility
HEAVY METAL QUAN EACH NES,83018,CPT,301,RC,,,,outpatient,,,356,35.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,21.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,45.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,23.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,21.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,23.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,47.46,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,22.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,21.96,448,,facility
IMMUNOASSAY QUANT NOS NONAB,83520,CPT,301,RC,,,,outpatient,,,675,67.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,36,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,66.08,66.08,66.08,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,41.18,24.82,318.38,1 through 10,percent of total billed charges,,,33.6,,37.63,37.63,96.43,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,33.6,23.18,176.4,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,36.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,87,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.22,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.27,448,,facility
CLOTTING FACTOR X ASSESSMENT TEST; DILUTED,85613,CPT,0305,RC,,,,outpatient,,,120,12,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,8.52,8.52,8.52,20,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,82.37,20.06,82.37,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,52.42,52.42,52.42,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,9.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,20.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,8.52,8.52,8.52,34,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,9.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.7,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,9.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,9.58,448,,facility
ASSAY THREE CATECHOLAMINES,82384,CPT,301,RC,,,,outpatient,,,72,7.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,22.46,22.46,22.46,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,25.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,52.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,26.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,22.46,22.46,22.46,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,25.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,26.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,54.57,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,25.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,25.25,448,,facility
ANTINUCLEAR ANTIBODIES,86038,CPT,302,RC,,,,outpatient,,,44,4.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.75,10.75,10.75,34,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,148.09,148.09,148.09,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,84.34,29.04,132.53,14,percent of total billed charges,,,33.6,,84.34,18.48,127.78,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,84.34,84.34,85.09,12,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,11.55,11.55,11.55,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.75,10.75,10.75,126,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.11,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.09,448,,facility
DETECT AGENT NOS DNA AMP,87798,CPT,306,RC,,,,outpatient,,,842,84.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,110.88,110.88,174.24,1 through 10,percent of total billed charges,,,33.6,,244.27,244.27,244.27,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,96.77,32.38,119.79,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,38.9,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
ASSAY OF URINE CREATININE,82570,CPT,301,RC,,,,outpatient,,,88,8.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.61,4.61,4.61,213,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,71.39,41.89,142.78,14,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,37.49,23.86,74.98,60,percent of total billed charges,,,33.6,,37.49,23.85,81.31,18,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,24.07,23.86,47.71,75,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,10.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,60.5,4.61,151,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,14.91,14.91,25.41,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,85.58,85.58,85.58,1 through 10,percent of total billed charges,,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.61,4.61,4.61,636,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.18,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.18,448,,facility
CARBOPLATIN INJECTION,J9045,HCPCS,636,RC,,,,outpatient,,,131,13.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,211.78,119.09,419.2,271,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,166.95,166.95,166.95,14,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,52.8,,155.18,46.48,276.67,168,percent of total billed charges,,,33.6,,90.64,84.58,104.34,56,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,27.51,18.45,86.26,49,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",448,448,,facility
TRANSLOCATION ANALYSIS (BCR/ABL1) MINOR BREAKPOINT,81207,CPT,0310,RC,,,,outpatient,,,1656,165.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,144.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,144.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,149.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,144.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,302.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,153.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,144.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,153.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,312.92,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,147.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,144.84,448,,facility
IMMUNOASSAY INFECTIOUS AGENT,86317,CPT,302,RC,,,,outpatient,,,210,21,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.33,13.33,13.33,86,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,59,59,59,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,52.8,26.54,52.8,41,percent of total billed charges,,,33.6,,52.8,33.6,52.8,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,33.6,33.6,33.73,52,percent of total billed charges,,,34.6,,218.53,218.53,218.53,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,31.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,50,50,50,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.33,13.33,13.33,209,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.38,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,15.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.99,448,,facility
GENE ANALYSIS (ABL PROTO-ONCOGENE 1; NON-RECEPTOR TYROSINE KINASE),81170,CPT,0310,RC,,,,outpatient,,,3981,398.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,300,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,300,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,309,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,300,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,627,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,318,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,266.85,266.85,266.85,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,300,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,318,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,525,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,306,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,300,627,,facility
MOPATH PROCEDURE LEVEL 6,81405,CPT,310,RC,,,,outpatient,,,1025,102.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,301.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,301.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,310.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,301.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,629.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,319.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,301.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,319.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,527.36,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,307.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,301.35,629.82,,facility
BLOOD UNIT COMPATIBILITY TEST; IMMEDIATE SPIN TECHNIQUE,86920,CPT,0302,RC,,,,outpatient,,,602,60.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,150.35,150.35,150.35,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,167.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,317.86,317.86,635.71,1 through 10,percent of total billed charges,,,33.6,,343.74,343.74,343.74,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,229.36,218.53,229.36,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,340.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,172.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,1264.2,1264.2,1264.2,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,14.05,14.05,14.05,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,172.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,226.07,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,166.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,163.06,448,,facility
WEST NILE VIRUS AB IGM,86788,CPT,302,RC,,,,outpatient,,,50,5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,63.5,63.5,63.5,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,35.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,14.99,14.99,14.99,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.4,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,16.85,448,,facility
ADENOVIRUS VACCINE TYPE 4,90476,CPT,636,RC,,,,outpatient,,,58,5.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
RUBELLA ANTIBODY,86762,CPT,302,RC,,,,outpatient,,,175,17.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.8,12.8,12.8,18,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,28.32,28.32,28.32,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,25.34,16.13,25.34,14,percent of total billed charges,,,33.6,,16.13,16.13,16.13,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,16.13,16.13,16.27,22,percent of total billed charges,,,34.6,,68.61,68.61,68.61,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,30.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,24,24,44.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,12.8,12.8,12.8,1 through 10,percent of total billed charges,,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.8,12.8,12.8,185,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,31.1,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.39,448,,facility
PSYCHOTHERAPY; 30 MINUTES,90832,CPT,0914,RC,,,,outpatient,,,481,48.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,140.97,140.97,152.83,43,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,169.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,169.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,174.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,169.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,355.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,180.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,169.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,180.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,173.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,169.87,448,,professional
MRI LOWER EXTREMITY W/O DYE,73718,CPT,610,RC,,,,outpatient,,,4999,499.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,786,,,,,,,case rate,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,728,,,,,,,case rate,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1025,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1350,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,235.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,477.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,242.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,242.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2407,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,232.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,228.36,2407,,facility
ENZYME CELL ACTIVITY,82657,CPT,301,RC,,,,outpatient,,,594,59.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.72,19.72,19.72,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,2094.14,2094.14,2094.14,1 through 10,percent of total billed charges,,,33.6,,762.96,762.96,762.96,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,46.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,23.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.72,19.72,19.72,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,23.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,39.01,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,22.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,22.17,448,,facility
T CELL ABSOLUTE COUNT/RATIO,86360,CPT,302,RC,,,,outpatient,,,1101,110.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,41.79,41.79,41.79,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,64.31,64.31,64.31,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,46.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,46.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,48.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,31.15,31.15,31.15,1 through 10,percent of total billed charges,,,33.6,,41.79,41.79,41.79,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,288.04,288.04,288.04,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,46.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,98.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,49.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,41.79,41.79,41.79,27,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,46.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,49.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,101.52,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,47.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,46.98,448,,facility
EXOME SEQUENCE ANALYSIS,81415,CPT,310,RC,,,,outpatient,,,1478,147.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4780,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4780,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4923.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4780,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,9990.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5066.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4780,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5066.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8365,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,4875.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,9990.2,,facility
CYTOGENETICS 100-300,88275,CPT,311,RC,,,,outpatient,,,1756,175.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,45.53,45.53,45.53,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,51.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,51.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,52.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,1828.51,1828.51,1828.51,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,401.18,401.18,401.18,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,51.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,106.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,54.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,45.53,45.53,45.53,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,51.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,54.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,89.58,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,52.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,51.19,448,,facility
IMFLUOR EA ADDL 1ANTB STN PX,88350,CPT,310,RC,,,,outpatient,,,306,30.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,26.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,55.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,28.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,26.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,28.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,76.23,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,27.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,26.49,448,,facility
FLUORESCENT ANTIBODY SCREEN,86255,CPT,302,RC,,,,outpatient,,,398,39.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.72,10.72,10.72,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,45.41,28.9,1068.67,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,28.9,28.9,28.9,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.72,10.72,10.72,19,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.04,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.05,448,,facility
SARSCOV2 VAC 25 MCG/.25ML IM,91321,CPT,636,RC,,,,outpatient,,,421,42.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare OPPS payment and based on reasonable cost. Payment determination is based on final charges.,,,,0,other,Payer contract is 100.00% of Medicare OPPS payment and based on reasonable cost. Payment determination is based on final charges. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare OPPS payment and based on reasonable cost. Payment determination is based on final charges.,,,,0,other,Payer contract is 100.00% of Medicare OPPS payment and based on reasonable cost. Payment determination is based on final charges. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare OPPS payment and based on reasonable cost. Payment determination is based on final charges.,,,,0,other,Payer contract is 103.00% of Medicare OPPS payment and based on reasonable cost. Payment determination is based on final charges. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare OPPS payment and based on reasonable cost. Payment determination is based on final charges.,,,,0,other,Payer contract is 100.00% of Medicare OPPS payment and based on reasonable cost. Payment determination is based on final charges. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare OPPS payment and based on reasonable cost. Payment determination is based on final charges.,,,,0,other,Payer contract is 209.00% of Medicare OPPS payment and based on reasonable cost. Payment determination is based on final charges. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare OPPS payment and based on reasonable cost. Payment determination is based on final charges.,,,,0,other,Payer contract is 106.00% of Medicare OPPS payment and based on reasonable cost. Payment determination is based on final charges. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare OPPS payment and based on reasonable cost. Payment determination is based on final charges.,,,,0,other,Payer contract is 100.00% of Medicare OPPS payment and based on reasonable cost. Payment determination is based on final charges. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare OPPS payment and based on reasonable cost. Payment determination is based on final charges.,,,,0,other,Payer contract is 106.00% of Medicare OPPS payment and based on reasonable cost. Payment determination is based on final charges. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,316.18,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,Payer contract is 102.00% of Medicare OPPS payment and based on reasonable cost. Payment determination is based on final charges.,,,,0,other,Payer contract is 102.00% of Medicare OPPS payment and based on reasonable cost. Payment determination is based on final charges. + No services performed during 15-month lookback period,316.18,448,,facility
SIROLIMUS LEVEL,80195,CPT,0300,RC,,,,outpatient,,,319,31.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,28.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.68,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.73,448,,facility
DETECT AGENT NOS DNA QUANT,87799,CPT,306,RC,,,,outpatient,,,1726,172.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,38.11,38.11,38.11,39,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,44.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,200.64,91.44,597.79,1 through 10,percent of total billed charges,,,33.6,,203.95,203.95,203.95,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,231.27,203.95,231.27,11,percent of total billed charges,,,34.6,,220.34,220.34,231.27,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,89.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,45.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,38.11,38.11,38.11,221,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,45.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,92.54,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,43.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,42.84,448,,facility
REMOVAL OF ANTIBODIES FROM SURFACE OF RED BLOOD CELL,86860,CPT,0302,RC,,,,outpatient,,,548,54.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,167.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,289.34,289.34,312.91,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,340.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,172.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,172.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,226.07,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,166.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,163.06,448,,facility
INITIAL HOSPITAL INPATIENT OR OBSERVATION VENTILATION ASSISTANCE AND MANAGEMENT,94002,CPT,0410,RC,,,,inpatient,,,7094,709.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Short Stay Lesser of + Days Threshold 1.00 + Stoploss First Dollar + Reimbursement Rate 57.00 + Basic Per Diem + Fixed Rate 5000.00 + Fixed Amount 157464.00,,,,0,other,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,Short Stay Lesser of + Days Threshold 1.00 + Stoploss First Dollar + Reimbursement Rate 72.00 + Basic Per Diem + Fixed Rate 10000.00 + Fixed Amount 56687.00,,,,0,other,NTE Percentage + Reimbursement Rate 85.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,47.3,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,facility
REPLACE FOOT DROP SPINT,L4394,HCPCS,274,RC,,,,outpatient,,,35,3.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,66,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,61,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,21.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,44.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,21.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,21.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,21.24,44.39,,facility
OTHER PROCEDURE ON PANCREAS,48999,CPT,0750,RC,,,,outpatient,,,3212,321.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,338.86,338.86,338.86,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,677.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,677.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,698.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,677.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1416.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,718.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,677.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,718.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2712,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,691.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,2712,,facility
MOPATH PROCEDURE LEVEL 8,81407,CPT,310,RC,,,,outpatient,,,850,85,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,846.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,846.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,871.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,846.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1768.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,897.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,846.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,897.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1480.97,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,863.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1768.7,,facility
DNA/RNA AMPLIFIED PROBE,87150,CPT,306,RC,,,,outpatient,,,613,61.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
APC GENE FULL SEQUENCE,81201,CPT,310,RC,,,,outpatient,,,480,48,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,780,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,780,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,803.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,780,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1630.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,826.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,780,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,826.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1365,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,795.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1630.2,,facility
ISLET CELL ANTIBODY,86341,CPT,302,RC,,,,outpatient,,,479,47.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,20.97,20.97,20.97,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,23.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,23.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,143.62,143.62,326.83,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,258.38,258.38,258.38,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,23.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,49.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,24.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,20.97,20.97,20.97,14,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,23.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,24.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.75,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,24.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,23.57,448,,facility
CULTURE SCREEN ONLY,87081,CPT,306,RC,,,,outpatient,,,347,34.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.9,5.9,5.9,191,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,192.64,5.9,192.64,17,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,277.89,277.89,277.89,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,148.9,101.14,158.93,15,percent of total billed charges,,,33.6,,148.9,101.14,158.93,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,101.14,95.6,101.14,34,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,13.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,7.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,150.5,141,150.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,63.21,63.21,63.21,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.9,5.9,5.9,279,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,7.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.32,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,6.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,6.63,448,,facility
BLOOC CLOT FACTOR V TEST,85220,CPT,305,RC,,,,outpatient,,,501,50.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,36.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.7,15.7,15.7,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.13,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.65,448,,facility
PALB2 GENE FULL GENE SEQ,81307,CPT,310,RC,,,,outpatient,,,420,42,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,676.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,676.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,696.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,676.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1413.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,717.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,676.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,717.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,495.04,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,690.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1413.88,,facility
DETECT AGENT NOS DNA QUANT,87799,CPT,306,RC,,,,outpatient,,,1391,139.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,38.11,38.11,38.11,39,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,44.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,200.64,91.44,597.79,1 through 10,percent of total billed charges,,,33.6,,203.95,203.95,203.95,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,231.27,203.95,231.27,11,percent of total billed charges,,,34.6,,220.34,220.34,231.27,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,89.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,45.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,38.11,38.11,38.11,221,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,45.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,92.54,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,43.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,42.84,448,,facility
RICKETTSIA ANTIBODY,86757,CPT,302,RC,,,,outpatient,,,279,27.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,17.21,17.21,17.21,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,40.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,20.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,17.21,17.21,17.21,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,20.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,41.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,19.35,448,,facility
CLOT INHIBIT PROT S FREE,85306,CPT,305,RC,,,,outpatient,,,90,9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.63,13.63,13.63,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,29.04,18.48,29.04,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,81.65,81.65,81.65,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,32.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.63,13.63,13.63,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,33.11,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,15.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,15.32,448,,facility
LISTERIA MONOCYTOGENES,86723,CPT,302,RC,,,,outpatient,,,164,16.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.49,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.19,448,,facility
SINGLE CONTRAST X-RAY OF ESOPHAGUS,74220,CPT,0320,RC,,,,outpatient,,,1377,137.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,881.28,881.28,881.28,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,172.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,786.27,786.27,786.27,1 through 10,percent of total billed charges,,,33.6,,462.67,462.67,462.67,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,462.67,462.67,462.67,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,350.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,177.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,54.76,54.76,54.76,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,177.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,171.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,167.87,448,,facility
ENCEPHALITIS CALIFORN ANTBDY,86651,CPT,302,RC,,,,outpatient,,,70,7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.49,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.19,448,,facility
KNEE-SHIN EXO MNL LOCK ULTRA,L5711,HCPCS,274,RC,,,,outpatient,,,978,97.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,66,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,61,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,663.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,663.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,683.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,663.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1387.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,703.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,663.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,703.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,676.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,663.71,1387.15,,facility
ENZYME CELL ACTIVITY,82657,CPT,301,RC,,,,outpatient,,,3860,386,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.72,19.72,19.72,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,2094.14,2094.14,2094.14,1 through 10,percent of total billed charges,,,33.6,,762.96,762.96,762.96,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,46.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,23.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.72,19.72,19.72,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,23.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,39.01,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,22.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,22.17,448,,facility
FLETCHER FACTOR (CLOTTING FACTOR) MEASUREMENT,85292,CPT,0305,RC,,,,outpatient,,,200,20,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,39.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,20.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,20.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,40.9,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.93,448,,facility
NFCT DS BV RNA VAG FLU ALG,81513,CPT,310,RC,,,,outpatient,,,1293,129.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,142.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,142.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,146.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,142.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,298.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,151.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,142.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,151.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,249.6,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,145.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,142.63,448,,facility
UNLISTED MOLECULAR PATHOLOGY,81479,CPT,310,RC,,,,outpatient,,,413,41.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,561.56,561.56,561.56,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,32.5,32.5,3071.5,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
URINARY LEG OR ABDOMEN BAG,A4358,HCPCS,272,RC,,,,outpatient,,,17,1.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",448,448,,facility
IMMUNOASSAY QUANT NOS NONAB,83520,CPT,301,RC,,,,outpatient,,,450,45,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,36,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,66.08,66.08,66.08,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,41.18,24.82,318.38,1 through 10,percent of total billed charges,,,33.6,,37.63,37.63,96.43,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,33.6,23.18,176.4,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,36.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,87,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.22,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.27,448,,facility
MANUAL URINALYSIS TEST WITH EXAMINATION USING MICROSCOPE; AUTOMATED,81001,CPT,0300,RC,,,,outpatient,,,400,40,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,6.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.86,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,3.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,3.17,448,,facility
M.TUBERCULO DNA AMP PROBE,87556,CPT,306,RC,,,,outpatient,,,11,1.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,41.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,41.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,41.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,87.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,44.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,41.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,44.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,42.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,41.68,448,,facility
BACTERIAL CULTURE; ANY SOURCE; EXCEPT BLOOD; ANAEROBIC,87075,CPT,0306,RC,,,,outpatient,,,683,68.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,8.42,8.42,8.42,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,229.49,229.49,306.67,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,229.49,229.49,229.49,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,9.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,19.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,8.42,8.42,8.42,55,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,9.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.46,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,9.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,9.47,448,,facility
HEAVY METAL QUAN EACH NES,83018,CPT,301,RC,,,,outpatient,,,256,25.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,21.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,45.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,23.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,21.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,23.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,47.46,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,22.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,21.96,448,,facility
CT SCAN OF CHEST BEFORE AND AFTER CONTRAST,71270,CPT,0352,RC,,,,outpatient,,,7915,791.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,403,,,,,,,case rate,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,371,,,,,,,case rate,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,875,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1050,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,172.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,350.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,177.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,177.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1522,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,171.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,167.87,1522,,facility
FOOT EXTERNAL KEEL SACH FOOT,L5970,HCPCS,274,RC,,,,outpatient,,,411,41.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,66,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,61,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,278.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,278.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,287,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,278.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,582.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,295.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,278.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,295.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,284.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,278.64,582.36,,facility
HFE GENE,81256,CPT,310,RC,,,,outpatient,,,932,93.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,58.14,58.14,58.14,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,65.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,65.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,67.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,65.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,136.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,69.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,65.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,69.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,141.21,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,66.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,65.36,448,,facility
MICROSOMAL ANTIBODY EACH,86376,CPT,302,RC,,,,outpatient,,,289,28.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.94,12.94,12.94,22,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,22.18,14.11,82.9,1 through 10,percent of total billed charges,,,33.6,,22.51,22.51,22.51,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,22.51,11.27,81.98,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,30.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.94,12.94,12.94,63,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,31.43,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.55,448,,facility
GALECTIN-3,82777,CPT,301,RC,,,,outpatient,,,300,30,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,44.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,44.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,45.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,44.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,92.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,46.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,44.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,46.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,77.44,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,45.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,44.25,448,,facility
SMEAR GRAM STAIN,87205,CPT,306,RC,,,,outpatient,,,362,36.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.8,3.8,3.8,30,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,180.48,3.16,180.48,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,166.38,166.38,166.38,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,94.75,94.75,148.9,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,94.75,94.75,95.6,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,8.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.8,3.8,3.8,139,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.22,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,4.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,4.27,448,,facility
COLLAGEN CROSSLINKS,82523,CPT,301,RC,,,,outpatient,,,729,72.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,39.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.62,16.62,16.62,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,40.37,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.68,448,,facility
REMOVAL OF TUNNELED CENTRAL VENOUS TUBE,36589,CPT,0481,RC,,,,outpatient,,,2449,244.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,600.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,600.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,618.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,600.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1254.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,636.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,600.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,636.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2712,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,612.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,2712,,facility
INJECTION OF CHEMICAL AGENT INTO FLUID COLLECTION USING IMAGING GUIDANCE,49185,CPT,0320,RC,,,,outpatient,,,2759,275.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,1421.6,1421.6,1421.6,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1628.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3303.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1675.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1675.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1612.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,443,3303.62,,facility
SIMPLE OR SINGLE DRAINAGE OF SKIN ABSCESS,10060,CPT,0450,RC,,,,outpatient,,,585,58.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,174.34,163.22,177.11,59,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,197.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,255.7,255.7,255.7,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,255.7,255.7,255.7,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,401.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,203.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,292.5,292.5,292.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,176.95,176.95,180.67,19,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,203.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,195.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,192.01,1173,,facility
X-RAY OF BOTH HIPS; 2 VIEWS,73521,CPT,0320,RC,,,,outpatient,,,1224,122.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,448,,facility
FLT3 GENE ANALYSIS,81246,CPT,310,RC,,,,outpatient,,,520,52,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,85.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,173.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,87.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,87.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,145.25,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,84.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,83,448,,facility
FOLIC ACID LEVEL; SERUM,82746,CPT,0301,RC,,,,outpatient,,,385,38.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.08,13.08,13.08,44,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,67.11,67.11,227.15,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,60.19,60.19,203.28,1 through 10,percent of total billed charges,,,33.6,,38.56,38.3,129.36,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,38.3,38.3,38.3,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,30.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,57,57,57,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,80.85,80.85,80.85,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.08,13.08,13.08,116,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,31.76,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.7,448,,facility
BENZODIAZEPINES1-12,80346,CPT,301,RC,,,,outpatient,,,289,28.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
GONADOTROPIN (REPRODUCTIVE HORMONE) ANALYSIS,84703,CPT,0301,RC,,,,outpatient,,,123,12.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,6.69,6.69,6.69,19,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,23.68,23.68,102.4,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,91.36,19.54,91.36,38,percent of total billed charges,,,33.6,,53.76,49.73,91.36,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,53.76,41.7,53.76,24,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,7.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,15.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,7.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,6.69,6.69,6.69,323,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,7.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,7.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.26,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,7.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,7.52,448,,facility
LIVER ENZYME (SGPT); LEVEL,84460,CPT,0301,RC,,,,outpatient,,,391,39.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.71,4.71,4.71,14,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,391,391,391,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,223.26,61.13,223.26,47,percent of total billed charges,,,33.6,,131.38,131.38,223.26,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,131.38,20.5,132.55,20,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,11.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,195.5,195.5,195.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.71,4.71,4.71,309,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.45,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.3,448,,facility
CT SCAN OF UPPER SPINE WITHOUT CONTRAST,72125,CPT,0352,RC,,,,outpatient,,,5246,524.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,93.3,92.3,197.02,18,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,403,,,,,,,case rate,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,371,,,,,,,case rate,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,875,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1050,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,2995.47,1762.66,2995.47,33,percent of total billed charges,,,33.6,,1762.66,1762.66,2995.47,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,1762.66,1762.66,1778.39,15,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,69.06,69.06,72.18,184,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1522,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,1522,,facility
HEMOGLOBIN ELECTROPHORESIS,83020,CPT,301,RC,,,,outpatient,,,244,24.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.45,11.45,11.45,22,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,12.1,12.1,12.29,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,26.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,18,18,18,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,29.19,29.19,29.19,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.45,11.45,11.45,47,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.81,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.87,448,,facility
KAFO PLAS DOUB FREE KNEE MOL,L2036,HCPCS,274,RC,,,,outpatient,,,3324,332.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,66,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,61,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Stoploss First Dollar + Reimbursement Rate 50.00 + Percent Of Charge + Reimbursement Rate 0.00 + Fixed Amount 3149.00,,,,0,other,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,Stoploss First Dollar + Reimbursement Rate 50.00 + Percent Of Charge + Reimbursement Rate 0.00 + Fixed Amount 3149.00,,,,0,other,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,2240.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2240.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2307.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2240.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,4682.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2374.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2240.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2374.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,2285.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,2240.26,4682.14,,facility
HETEROPHILE ANTIBODY SCREEN,86308,CPT,302,RC,,,,outpatient,,,43,4.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.61,4.61,4.61,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,138.77,138.77,224.4,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,133.23,133.23,133.23,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,10.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.61,4.61,4.61,39,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.18,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.18,448,,facility
DRUG SCREENING BARBITURATES,80345,CPT,301,RC,,,,outpatient,,,1076,107.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
CONTRAST INJECTION FOR IMAGING TO EVALUATE CENTRAL VENOUS ACCESS DEVICE,36598,CPT,0361,RC,,,,outpatient,,,1090,109,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,187.77,187.77,187.77,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,203.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,203.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,209.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,404.54,404.54,404.54,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,203.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,425.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,215.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,203.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,215.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2440,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,207.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,203.57,2440,,facility
"INJECTION, UDENYCA 0.5 MG",Q5111,HCPCS,636,RC,,,,outpatient,,,1283,128.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,9853.44,9853.44,9853.44,12,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,149.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,149.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,153.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,8129.09,5219.24,8129.09,132,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,5219.24,5219.24,5219.24,12,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,149.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,311.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,158.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,149.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,158.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,291.43,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,152.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,149.13,448,,facility
CHORIONIC GONADOTROPIN TEST,84702,CPT,301,RC,,,,outpatient,,,73,7.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.39,13.39,13.39,99,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,35.99,35.99,146.32,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,32.21,32.21,141.61,16,percent of total billed charges,,,33.6,,32.21,20.5,83.33,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,20.5,20.5,83.33,45,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,31.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,12.81,12.81,12.81,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,13.39,13.39,13.39,1 through 10,percent of total billed charges,,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.39,13.39,13.39,208,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.53,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,15.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,15.05,448,,facility
DETECT AGENT NOS DNA AMP,87798,CPT,306,RC,,,,outpatient,,,214,21.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,110.88,110.88,174.24,1 through 10,percent of total billed charges,,,33.6,,244.27,244.27,244.27,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,96.77,32.38,119.79,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,38.9,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
X-RAY OF THIGH BONE; MINIMUM 2 VIEWS,73552,CPT,0320,RC,,,,outpatient,,,1133,113.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,85.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,174.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,21.83,21.83,22.47,28,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,84.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,83.29,448,,facility
PROTEIN WESTERN BLOT TEST,84182,CPT,301,RC,,,,outpatient,,,87,8.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,217.54,217.54,217.54,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,29.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,61.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,30.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,25.98,25.98,25.98,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,29.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,30.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,51.12,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,29.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,29.21,448,,facility
ABL1 GENE,81170,CPT,310,RC,,,,outpatient,,,1596,159.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,300,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,300,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,309,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,300,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,627,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,318,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,266.85,266.85,266.85,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,300,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,318,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,525,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,306,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,300,627,,facility
BLOOD GLUCOSE (SUGAR) TOLERANCE TEST; EACH ADDITIONAL BEYOND 3 SPECIMENS,82952,CPT,0301,RC,,,,outpatient,,,38.5,3.85,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,20.59,20.33,43.82,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,13.1,13.05,13.1,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,8.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.47,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,3.92,448,,facility
CMPLX RPR TRUNK 2.6-7.5 CM,13101,CPT,450,RC,,,,outpatient,,,1579,157.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1027,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1519,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,707.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,707.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,728.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,707.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1478.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,749.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,707.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,749.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,721.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1519,,facility
UNLISTED MOLECULAR PATHOLOGY,81479,CPT,310,RC,,,,outpatient,,,1740,174,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,561.56,561.56,561.56,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,32.5,32.5,3071.5,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
CHROMIUM LEVEL TO TEST FOR POISONING OR DEFICIENCY,82495,CPT,0301,RC,,,,outpatient,,,254,25.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,20.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,42.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,21.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,20.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,21.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,43.82,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,20.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,20.28,448,,facility
DETECTION TEST BY NUCLEIC ACID FOR ORGANISM; QUANTIFICATION,87799,CPT,0306,RC,,,,outpatient,,,240,24,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,38.11,38.11,38.11,39,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,44.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,200.64,91.44,597.79,1 through 10,percent of total billed charges,,,33.6,,203.95,203.95,203.95,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,231.27,203.95,231.27,11,percent of total billed charges,,,34.6,,220.34,220.34,231.27,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,89.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,45.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,38.11,38.11,38.11,221,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,45.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,92.54,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,43.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,42.84,448,,facility
INJECTION OF ESOPHAGUS; STOMACH; AND/OR UPPER SMALL BOWEL USING A FLEXIBLE ENDOSCOPE,43236,CPT,0750,RC,,,,outpatient,,,4012,401.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,800.68,800.68,800.68,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,868.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,868.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,894.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,868.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1814.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,920.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,868.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,920.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3821,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,885.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3821,,facility
EVALUATION OF HEART FUNCTION USING TILT TABLE,93660,CPT,0480,RC,,,,outpatient,,,4072,407.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,336.03,329.42,465.55,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,357.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,357.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,367.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,357.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,746.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,378.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,472.51,472.51,472.51,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,357.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,378.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1463,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,364.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,357.13,1463,,facility
AK UNIV MULTIPLEX SYS FRICT,L5616,HCPCS,274,RC,,,,outpatient,,,3260,326,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,66,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,61,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Stoploss First Dollar + Reimbursement Rate 50.00 + Percent Of Charge + Reimbursement Rate 0.00 + Fixed Amount 3149.00,,,,0,other,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,Stoploss First Dollar + Reimbursement Rate 50.00 + Percent Of Charge + Reimbursement Rate 0.00 + Fixed Amount 3149.00,,,,0,other,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,2216.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2216.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2283.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2216.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,4633.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2349.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2216.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2349.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,2261.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,2216.96,4633.45,,facility
OSTEOCALCIN (BONE PROTEIN) LEVEL,83937,CPT,0301,RC,,,,outpatient,,,344,34.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,29.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,62.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,31.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,26.55,26.55,26.55,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,29.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,31.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,64.49,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,30.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,29.85,448,,facility
X-RAY EXAM OF LOWER LEG,73590,CPT,320,RC,,,,outpatient,,,1488,148.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,85.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,174.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.41,19.41,19.97,77,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,84.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,83.29,448,,facility
MLH1 GENE FULL SEQ,81292,CPT,310,RC,,,,outpatient,,,419,41.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,675.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,675.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,695.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,675.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1411.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,715.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,675.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,715.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1181.95,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,688.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1411.59,,facility
DNA/RNA AMPLIFIED PROBE,87150,CPT,306,RC,,,,outpatient,,,508,50.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
FLUORESCENT ANTIBODY SCREEN,86255,CPT,302,RC,,,,outpatient,,,780,78,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.72,10.72,10.72,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,45.41,28.9,1068.67,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,28.9,28.9,28.9,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.72,10.72,10.72,19,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.04,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.05,448,,facility
ULTRASOUND OF HEART; FOLLOW-UP,93308,CPT,0480,RC,,,,outpatient,,,1290,129,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,212.09,198.56,214.86,62,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,851.2,851.2,851.2,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,235.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,702.24,702.24,702.24,1 through 10,percent of total billed charges,,,33.6,,446.88,446.88,702.24,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,437.31,437.31,437.31,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,477.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,242.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,215.26,214.86,215.26,40,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,242.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1463,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,232.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,228.36,1463,,facility
CYTOGENETICS DNA PROBE,88271,CPT,311,RC,,,,outpatient,,,878,87.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.05,19.05,19.05,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,1274.11,1274.11,1274.11,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,477.79,477.79,477.79,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,21.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,44.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.05,19.05,19.05,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,21.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,46.27,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,21.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,21.42,448,,facility
MOPATH PROCEDURE LEVEL 2,81401,CPT,310,RC,,,,outpatient,,,1338,133.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,121.86,121.86,121.86,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,137,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,137,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,141.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,137,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,286.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,145.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,137,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,145.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,239.75,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,139.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,137,448,,facility
SUSPENSION SLEEVE LOWER EXT,L2397,HCPCS,274,RC,,,,outpatient,,,202,20.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,66,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,61,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,134.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,134.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,138.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,134.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,281.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,142.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,134.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,142.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,137.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,134.68,281.48,,facility
M.TUBERCULO DNA AMP PROBE,87556,CPT,306,RC,,,,outpatient,,,200,20,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,41.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,41.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,41.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,87.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,44.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,41.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,44.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,42.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,41.68,448,,facility
M. GENITALIUM AMP PROBE,87563,CPT,306,RC,,,,outpatient,,,239,23.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,61.41,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
MEASUREMENT OF PANCREATIC ELASTASE (ENZYME) IN STOOL,82653,CPT,0301,RC,,,,outpatient,,,196,19.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,20.43,20.43,20.43,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,23.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,262.42,103.49,262.42,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,65.86,65.86,65.86,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,48.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,24.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,20.43,20.43,20.43,28,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,24.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,40.2,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,23.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,22.97,448,,facility
"INJ, STIMUFEND, 0.5 MG",Q5127,HCPCS,636,RC,,,,outpatient,,,1505,150.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,143.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,,,0,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00 + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,143.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,,,0,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00 + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,152.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,0,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,641.37,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,,,,0,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00 + No services performed during 15-month lookback period,143.67,641.37,,facility
OTHER PROCEDURE ON STOMACH,43999,CPT,0750,RC,,,,outpatient,,,4087,408.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,868.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,868.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,894.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,868.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1814.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,920.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,868.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,920.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3821,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,885.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3821,,facility
AK PELVIC CONTROL BELT PAD/L,L5694,HCPCS,274,RC,,,,outpatient,,,440,44,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,66,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,61,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,296.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,296.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,305.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,296.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,618.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,313.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,296.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,313.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,302.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,296.13,618.91,,facility
MICRODISSECTION MANUAL,88381,CPT,310,RC,,,,outpatient,,,1462,146.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,93.74,93.74,93.74,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,21.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,44.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,21.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,172.62,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,21.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,21.51,448,,facility
IRRADIATION OF BLOOD PRODUCT; EACH UNIT,86945,CPT,0302,RC,,,,outpatient,,,98,9.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,74.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,55.65,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,36.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.74,448,,facility
TIBIAL LENGTH SOCK FX OR EQU,L2840,HCPCS,274,RC,,,,outpatient,,,100,10,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,66,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,61,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,66.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,66.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,68.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,66.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,139.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,70.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,66.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,70.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,68.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,66.94,139.9,,facility
MICROSCOPIC EXAMINATION FOR WHITE BLOOD CELLS WITH MANUAL CELL COUNT,85007,CPT,0305,RC,,,,outpatient,,,636,63.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.38,3.38,3.38,135,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,407.04,8.32,467.84,76,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,7.67,7.67,431.29,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,385.97,6.86,417.4,56,percent of total billed charges,,,33.6,,245.62,245.62,245.62,33,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,242.32,4.37,245.62,60,percent of total billed charges,,,34.6,,265.35,265.35,265.35,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,7.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,6.5,3.38,365.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,153.51,153.51,153.51,1 through 10,percent of total billed charges,,,35,,318,318,318,1 through 10,percent of total billed charges,,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.38,3.38,3.38,861,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.42,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,3.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,3.8,448,,facility
SPECIMEN ANALYSIS FOR BLOOD,82271,CPT,0301,RC,,,,outpatient,,,103,10.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,11.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.73,4.73,4.73,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.31,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.32,448,,facility
FERRITIN (BLOOD PROTEIN) LEVEL,82728,CPT,0301,RC,,,,outpatient,,,314,31.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.12,12.12,12.12,348,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,56.64,56.64,185.26,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,50.69,32.26,165.79,96,percent of total billed charges,,,33.6,,32.26,32.26,165.79,18,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,32.26,32.26,105.5,115,percent of total billed charges,,,34.6,,116.18,116.18,116.18,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,28.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,48,48,48,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,65.94,20.16,65.94,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.12,12.12,12.12,882,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.45,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.63,448,,facility
TEST FOR EXERCISE-INDUCED HEART AND LUNG STRESS,94621,CPT,0460,RC,,,,outpatient,,,3812,381.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,296.21,273.22,357.13,21,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,2439.68,2439.68,2439.68,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,357.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,357.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,367.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,2012.74,2012.74,2012.74,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,357.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,746.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,378.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,71.71,71.71,73.52,19,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,357.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,378.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,611,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,364.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,357.13,746.4,,facility
KO ELASTIC W/JOINTS PRE OTS,L1812,HCPCS,274,RC,,,,outpatient,,,202,20.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,66,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,61,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,70.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,70.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,72.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,70.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,146.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,74.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,70.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,74.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,71.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,70.12,146.55,,facility
CLOT FACTOR X STUART-POWER,85260,CPT,305,RC,,,,outpatient,,,55,5.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,37.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.92,0.22,15.92,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.68,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.9,448,,facility
RIA NONANTIBODY,83519,CPT,301,RC,,,,outpatient,,,3013,301.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,55.44,55.44,55.44,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.37,16.37,16.37,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.2,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.4,448,,facility
INJ ONTRUZANT 10 MG,Q5112,HCPCS,636,RC,,,,outpatient,,,371,37.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,20.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,20.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,43.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,20.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,56.7,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,21.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,20.99,448,,facility
ASSAY OF C-PEPTIDE,84681,CPT,301,RC,,,,outpatient,,,232,23.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,18.51,18.51,18.51,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,283.54,283.54,283.54,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,54.1,54.1,54.58,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,20.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,43.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,18.51,18.51,18.51,11,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,20.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,44.98,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,21.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,20.81,448,,facility
QUANTITATIVE ASSAY DRUG,80299,CPT,301,RC,,,,outpatient,,,594,59.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,13,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,174.64,174.64,174.64,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,171.6,171.6,171.6,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,374.52,374.52,374.52,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.62,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.64,448,,facility
VARICELLA-ZOSTER ANTIBODY,86787,CPT,302,RC,,,,outpatient,,,205,20.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.46,11.46,11.46,39,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,82.6,23.01,82.6,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,47.54,20.59,129.19,22,percent of total billed charges,,,33.6,,47.04,47.04,266.64,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,47.04,47.04,47.54,21,percent of total billed charges,,,34.6,,221.19,221.19,221.19,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,26.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,70,70,252.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,24.36,24.36,24.36,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,11.46,11.46,11.46,1 through 10,percent of total billed charges,,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.46,11.46,11.46,200,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.88,448,,facility
M.TUBERCULO DNA AMP PROBE,87556,CPT,306,RC,,,,outpatient,,,745,74.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,41.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,41.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,41.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,87.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,44.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,41.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,44.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,42.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,41.68,448,,facility
DRUG SCREENING COCAINE,80353,CPT,301,RC,,,,outpatient,,,309,30.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
ULTRASOUND OF HEART WITH PROBE IN ESOPHAGUS DURING SURGERY ON HEART OR GREAT BLOOD VESSELS WITH REPORT,93355,CPT,0480,RC,,,,outpatient,,,9404,940.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,186.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,186.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,192,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,186.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,389.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,197.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,186.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,197.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1463,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,190.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,186.41,1463,,facility
DETECTION TEST BY NUCLEIC ACID FOR TRICHOMONAS VAGINALIS (GENITAL PARASITE); DIRECT PROBE TECHNIQUE,87660,CPT,0306,RC,,,,outpatient,,,319,31.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,20.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,41.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,21.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,20.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,21.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,43.33,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,20.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,20.05,448,,facility
ASSAY OF CALCIUM IN URINE,82340,CPT,301,RC,,,,outpatient,,,31,3.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.36,5.36,5.36,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,19.15,19.15,123.98,1 through 10,percent of total billed charges,,,33.6,,123.98,123.98,123.98,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,19.15,19.15,19.15,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,12.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.36,5.36,5.36,54,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.02,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,6.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,6.03,448,,facility
CULTURE SCREEN ONLY,87081,CPT,306,RC,,,,outpatient,,,315,31.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.9,5.9,5.9,191,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,192.64,5.9,192.64,17,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,277.89,277.89,277.89,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,148.9,101.14,158.93,15,percent of total billed charges,,,33.6,,148.9,101.14,158.93,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,101.14,95.6,101.14,34,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,13.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,7.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,150.5,141,150.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,63.21,63.21,63.21,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.9,5.9,5.9,279,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,7.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.32,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,6.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,6.63,448,,facility
PHENOBARBITAL LEVEL,80184,CPT,0301,RC,,,,outpatient,,,50,5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,31.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.61,13.61,13.61,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.78,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,15.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,15.3,448,,facility
N.GONORRHOEAE DNA AMP PROB,87591,CPT,306,RC,,,,outpatient,,,35,3.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,442,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,50.15,20.65,65.49,11,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,228.48,228.48,228.48,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,37.3,18.48,58.61,60,percent of total billed charges,,,33.6,,37.3,11.76,63.38,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,28.82,11.76,37.3,69,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,42.5,17.5,55.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,23.31,23.31,23.31,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,31.21,31.21,31.21,1 through 10,percent of total billed charges,,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,796,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
IMMUNOASSAY NONANTIBODY,83516,CPT,301,RC,,,,outpatient,,,400,40,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9,9,10.26,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,4.75,4.75,218.59,30,percent of total billed charges,,,33.6,,3.02,3.02,175.39,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,3.02,3.02,211.68,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,24.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,23.5,23.5,23.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9,9,10.26,51,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.92,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,11.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.53,448,,facility
DETECT AGENT NOS DNA AMP,87798,CPT,306,RC,,,,outpatient,,,962,96.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,110.88,110.88,174.24,1 through 10,percent of total billed charges,,,33.6,,244.27,244.27,244.27,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,96.77,32.38,119.79,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,38.9,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
ASSAY OF URINE/URIC ACID,84560,CPT,301,RC,,,,outpatient,,,258,25.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.52,4.52,4.52,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,10.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.26,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.08,448,,facility
ELECTRON MICROSCOPY DX,88348,CPT,310,RC,,,,outpatient,,,3816,381.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,716.75,711.24,771.08,14,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,2202.88,1496.32,2202.88,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,771.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,771.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,794.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,771.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1611.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,817.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,337.34,337.34,341.35,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,771.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,817.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,946.68,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,786.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1611.56,,facility
EPSTEIN-BARR CAPSID VCA,86665,CPT,302,RC,,,,outpatient,,,469,46.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.14,16.14,16.14,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,106.24,61.44,106.24,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,87.65,87.65,759.96,1 through 10,percent of total billed charges,,,33.6,,345.41,345.41,345.41,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,65.86,65.86,345.41,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,37.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.14,16.14,16.14,21,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,39.2,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.14,448,,facility
USE OF A DRUG TO INDUCE DEPRESSION OF CONSCIOUSNESS BY PHYSICIAN NOT PERFORMING A PROCEDURE (YOUNGER THAN 5 YEARS); INITIAL 15 MINUTES,99155,CPT,0370,RC,,,,outpatient,,,1121,112.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,3911.04,3911.04,3911.04,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,52.8,,680.59,680.59,680.59,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,139.67,139.67,261.9,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",448,448,,facility
ULTRASOUND OF HEART FOR CONGENITAL DEFECT,93303,CPT,0480,RC,,,,outpatient,,,5170,517,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,481.08,450.38,492.05,472,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,3805.44,3308.8,3805.44,37,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,3508.14,3508.14,3508.14,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,522.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,522.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,538.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,3139.49,1997.86,3139.49,48,percent of total billed charges,,,33.6,,1997.86,1997.86,1997.86,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,1997.86,1752.63,1997.86,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,522.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1092.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,554.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,2973,2585,2973,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,488.27,488.27,492.05,307,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,522.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,554.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1463,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,533.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1463,,facility
AK FLEX INNER SOCKET EXT FRA,L5651,HCPCS,274,RC,,,,outpatient,,,2908,290.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,66,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,61,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1960.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1960.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2019.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1960.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,4097.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2077.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1960.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2077.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,1999.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,1960.29,4097.01,,facility
ULTRASOUND SCAN OF PELVIC REGION THROUGH RECTUM,76872,CPT,0402,RC,,,,outpatient,,,1161,116.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,465,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,465,,facility
C-PEPTIDE (PROTEIN) LEVEL,84681,CPT,0301,RC,,,,outpatient,,,161,16.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,18.51,18.51,18.51,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,283.54,283.54,283.54,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,54.1,54.1,54.58,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,20.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,43.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,18.51,18.51,18.51,11,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,20.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,44.98,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,21.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,20.81,448,,facility
ENCEPHALITIS CALIFORN ANTBDY,86651,CPT,302,RC,,,,outpatient,,,52,5.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.49,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.19,448,,facility
NFCT AGT GNTYP ALYS HIV1,87906,CPT,306,RC,,,,outpatient,,,2660,266,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,120.95,120.95,120.95,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,128.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,128.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,132.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,108.24,108.24,108.24,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,128.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,269.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,136.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,114.5,114.5,114.5,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,128.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,136.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,278.11,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,131.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,128.73,448,,facility
ASSAY PH BODY FLUID NOS,83986,CPT,301,RC,,,,outpatient,,,83,8.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.18,3.18,3.18,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,75.43,75.43,75.43,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,7.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.18,3.18,3.18,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.74,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,3.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,3.58,448,,facility
TEST FOR EXERCISE-INDUCED LUNG STRESS,94618,CPT,0460,RC,,,,outpatient,,,388,38.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,248.32,248.32,248.32,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,131.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,204.86,130.37,204.86,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,266.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,134.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.23,10.23,10.25,15,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,134.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,611,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,129.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,127.33,611,,facility
REMOVAL OF FOREIGN BODIES IN LARGE BOWEL USING A FLEXIBLE ENDOSCOPE,45379,CPT,0750,RC,,,,outpatient,,,4873,487.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1179.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,1882.94,1882.94,1882.94,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,2393.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1213.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1213.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3821,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1168.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3821,,facility
NORMAL SALINE SOLUTION INFUS,J7030,HCPCS,636,RC,,,,outpatient,,,7,0.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,4.13,4.13,4.13,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,52.8,,3.7,3.29,24.05,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,4.9,3.52,7,20,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",448,448,,facility
QUANTITATIVE ASSAY DRUG,80299,CPT,301,RC,,,,outpatient,,,62,6.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,13,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,174.64,174.64,174.64,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,171.6,171.6,171.6,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,374.52,374.52,374.52,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.62,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.64,448,,facility
AMINO ACIDS SINGLE QUANT,82131,CPT,301,RC,,,,outpatient,,,56,5.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,23.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,48.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,24.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,24.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,40.22,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,23.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,22.98,448,,facility
X-RAY OF FOOT; MINIMUM OF 3 VIEWS,73630,CPT,0320,RC,,,,outpatient,,,1089,108.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,85.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,174.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,21.02,21.02,21.91,84,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,84.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,83.29,448,,facility
BELOW KNEE ACRYLIC SOCKET,L5629,HCPCS,274,RC,,,,outpatient,,,771,77.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,66,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,61,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,518.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,518.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,534.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,518.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1084.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,549.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,518.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,549.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,529.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,518.74,1084.17,,facility
UNLISTED MOLECULAR PATHOLOGY,81479,CPT,310,RC,,,,outpatient,,,1473,147.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,561.56,561.56,561.56,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,32.5,32.5,3071.5,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
"OCTREOTIDE INJECTION, DEPOT",J2353,HCPCS,636,RC,,,,outpatient,,,853,85.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,208.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,208.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,214.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,208.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,434.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,220.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,208.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,220.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,469.5,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,212.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,208.1,469.5,,facility
CAST SUP SHT ARM SPLINT FBRG,Q4022,HCPCS,270,RC,,,,outpatient,,,47,4.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,32.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,15.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,15.5,448,,facility
SPECTROPHOTOMETRY,84311,CPT,301,RC,,,,outpatient,,,1491,149.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,7.2,7.2,7.2,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,45.35,45.35,53.33,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,16.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,7.2,7.2,7.2,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.1,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,8.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,8.1,448,,facility
THYROXINE BINDING GLOBULIN (THYROID RELATED PROTEIN) LEVEL,84442,CPT,0301,RC,,,,outpatient,,,62.1,6.21,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.15,13.15,13.15,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,30.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,31,31,31,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.15,13.15,13.15,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,31.94,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,15.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.78,448,,facility
BLOOD TYPING SEROLOGIC RH(D),86901,CPT,302,RC,,,,outpatient,,,33,3.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,2.66,2.66,62.15,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,155.76,19.47,155.76,14,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,88.7,17.42,150.74,116,percent of total billed charges,,,33.6,,88.7,17.42,88.7,44,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,88.7,11.09,100.58,78,percent of total billed charges,,,34.6,,97.68,95.83,100.58,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,74.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,132,16.5,132,13,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,55.44,6.93,55.44,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,2.66,2.66,2.66,1 through 10,percent of total billed charges,,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,2.66,2.66,2.66,829,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.46,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,36.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,6.46,448,,facility
BK MOLDED DISTAL CUSHION,L5668,HCPCS,274,RC,,,,outpatient,,,246,24.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,66,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,61,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,164.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,164.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,169.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,164.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,344.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,174.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,164.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,174.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,168.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,164.84,344.52,,facility
INTERMEDIATE REPAIR OF WOUND OF FACE; EARS; EYELIDS; NOSE; LIPS; OR MOUTH; 2.5 CM OR LESS,12051,CPT,0450,RC,,,,outpatient,,,1026,102.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,350.55,175.27,366.07,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,400.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,761.71,761.71,761.71,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,813.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,412.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,355.79,355.79,355.79,12,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,412.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,396.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,389.05,1173,,facility
ASSAY OF RBC GALACTOKINASE,82759,CPT,301,RC,,,,outpatient,,,1105,110.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,21.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,44.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,21.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,46.41,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,21.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,21.48,448,,facility
IMFLUOR EA ADDL 1ANTB STN PX,88350,CPT,310,RC,,,,outpatient,,,226,22.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,26.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,55.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,28.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,26.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,28.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,76.23,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,27.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,26.49,448,,facility
IMHCHEM/IMCYTCHM EA ADD ANTB,88341,CPT,310,RC,,,,outpatient,,,644,64.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,253.44,84.48,824.32,63,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,155.76,77.88,233.64,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,432.77,216.38,1514.69,32,percent of total billed charges,,,33.6,,330,209.09,2163.84,23,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,432.77,44.35,1298.3,46,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,25.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,53.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,27.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,1610,1610,1610,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,55.86,53.04,55.86,82,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,25.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,27.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,113.4,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,26.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,25.79,448,,facility
INSERTION OF TUBE OR TUBE IN ESOPHAGUS; STOMACH; AND/OR UPPER SMALL BOWEL USING A FLEXIBLE ENDOSCOPE,43241,CPT,0750,RC,,,,outpatient,,,8621,862.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,1836.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1836.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1891.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1836.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3838.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1946.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1836.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1946.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3821,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1873.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3838.31,,facility
X-RAY EXAM OF KNEE 1 OR 2,73560,CPT,320,RC,,,,outpatient,,,1611,161.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,85.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,174.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,21.02,21.02,21.91,57,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,84.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,83.29,448,,facility
EVALUATION OF ANTIMICROBIAL DRUG (ANTIBIOTIC; ANTIFUNGAL; ANTIVIRAL),87184,CPT,0306,RC,,,,outpatient,,,392,39.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,7.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,15.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,7.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,6.65,6.65,6.65,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,7.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,7.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.89,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,7.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,7.48,448,,facility
CCP ANTIBODY,86200,CPT,302,RC,,,,outpatient,,,291,29.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.52,11.52,11.52,14,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,70.8,70.8,70.8,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,63.36,25.87,63.36,1 through 10,percent of total billed charges,,,33.6,,40.32,40.32,63.36,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,33.26,16.46,40.68,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.52,11.52,11.52,56,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.97,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.95,448,,facility
STATIC OR DYNAMI AFO PRE CST,L4396,HCPCS,274,RC,,,,outpatient,,,308,30.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,66,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,61,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,207.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,207.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,213.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,207.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,433.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,219.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,207.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,219.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,211.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,207.4,433.47,,facility
X-RAY OF SHOULDER; 1 VIEW,73020,CPT,0320,RC,,,,outpatient,,,1022,102.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,85.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,174.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,84.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,83.29,448,,facility
BRUCELLA ANTIBODY,86622,CPT,302,RC,,,,outpatient,,,60,6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,18.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,9.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,7.94,7.94,7.94,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,9.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.3,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,9.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,8.93,448,,facility
BLD TYPING SEROLOGIC RH PHNT,86906,CPT,305,RC,,,,outpatient,,,78,7.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,74.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.75,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,36.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,16.75,448,,facility
COAGULATION TIME ACTIVATED,85347,CPT,305,RC,,,,outpatient,,,340,34,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,57.12,38.17,224.4,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,8.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.81,3.81,3.81,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.21,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,4.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,4.28,448,,facility
DETECTION TEST BY NUCLEIC ACID FOR CHLAMYDIA PNEUMONIAE; AMPLIFIED PROBE TECHNIQUE,87486,CPT,0306,RC,,,,outpatient,,,1041,104.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
QUANTITATIVE ASSAY DRUG,80299,CPT,301,RC,,,,outpatient,,,303,30.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,13,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,174.64,174.64,174.64,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,171.6,171.6,171.6,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,374.52,374.52,374.52,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.62,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.64,448,,facility
CT SCAN OF SOFT TISSUE OF NECK WITHOUT CONTRAST,70490,CPT,0351,RC,,,,outpatient,,,5279,527.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,195.35,92.3,197.02,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,378,378,378,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,875,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1050,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,2787.31,2787.31,2787.31,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,1773.74,1773.74,1773.74,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,74.45,74.45,78.01,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1522,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,1522,,facility
BACTERIAL CULTURE FOR ANAEROBIC ISOLATES,87076,CPT,0306,RC,,,,outpatient,,,669,66.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,16.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,334.5,334.5,334.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,7.19,7.19,14.38,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.45,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,8.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,8.08,448,,facility
CHANGE OF BREATHING TUBE IN WINDPIPE,31502,CPT,0360,RC,,,,outpatient,,,1488,148.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,226.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,226.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,233.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,226.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,473.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,240.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,226.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,240.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2440,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,231.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,226.68,2440,,facility
X-RAY OF SKULL; 1-3 VIEWS,70250,CPT,0320,RC,,,,outpatient,,,1061,106.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,625.99,625.99,625.99,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,356.5,356.5,560.21,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,530.5,530.5,530.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,22.1,22.1,22.75,27,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,448,,facility
ENCEPHALTIS WEST EQNE ANTBDY,86654,CPT,302,RC,,,,outpatient,,,130,13,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.49,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.19,448,,facility
ULTRASOUND OF HEART WITH PROBE IN ESOPHAGUS FOR CONGENITAL DEFECT; WITH REPORT,93315,CPT,0480,RC,,,,outpatient,,,8523,852.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,481.08,481.08,6741.13,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,522.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,522.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,538.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,522.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1092.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,554.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,488.27,488.27,488.27,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,522.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,554.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1463,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,533.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1463,,facility
REMOVAL AND MICROSCOPIC EXAM OF GROWTH OF TRUNK; ARMS; OR LEGS; EACH ADDITIONAL STAGE; 1-5 TISSUE BLOCKS,17314,CPT,0761,RC,,,,outpatient,,,798,79.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,134.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,134.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,138.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,134.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,280.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,142.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,134.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,142.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,136.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,134.2,1173,,facility
HLA CLASS I&II ANTIBODY QUAL,86828,CPT,302,RC,,,,outpatient,,,57,5.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,64.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,64.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,66.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,129.36,129.36,129.36,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,64.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,134.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,68.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,64.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,68.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,112.33,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,65.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,64.19,448,,facility
QUANTITATIVE ASSAY DRUG,80299,CPT,301,RC,,,,outpatient,,,305,30.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,13,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,174.64,174.64,174.64,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,171.6,171.6,171.6,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,374.52,374.52,374.52,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.62,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.64,448,,facility
FIBRINOGEN (FACTOR 1) ANTIGEN DETECTION,85385,CPT,0305,RC,,,,outpatient,,,85.5,8.55,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.86,12.86,12.86,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,30.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.86,12.86,12.86,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.31,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.46,448,,facility
ANALYSIS FOR ANTIBODY TO CHLAMYDIA (BACTERIA),86631,CPT,0302,RC,,,,outpatient,,,35,3.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,24.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.55,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.82,448,,facility
ENDOSKEL KNEE-SHIN MNL LOCK,L5810,HCPCS,274,RC,,,,outpatient,,,969,96.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,66,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,61,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,658.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,658.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,677.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,658.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1375.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,697.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,658.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,697.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,671.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,658.08,1375.39,,facility
DESTRUCTION OF PRECANCER SKIN GROWTH; 1 GROWTH,17000,CPT,0761,RC,,,,outpatient,,,547,54.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,197.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,401.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,203.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,176.95,176.95,180.67,15,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,203.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,195.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,192.01,1173,,facility
RED BLOOD CELL SEDIMENTATION RATE; TO DETECT INFLAMMATION; AUTOMATED,85652,CPT,0305,RC,,,,outpatient,,,258,25.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,2.4,2.4,2.4,155,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,12.8,12.8,12.8,42,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,11.8,11.8,11.8,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,10.56,6.72,147.32,64,percent of total billed charges,,,33.6,,10.56,6.72,86.69,12,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,6.78,6.72,86.69,51,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,5.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,10,10,129,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,4.2,4.2,4.2,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,2.4,2.4,2.4,674,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,2.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,2.7,448,,facility
NFCT AGT GNTYP ALYS HEP C,87902,CPT,306,RC,,,,outpatient,,,3641,364.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,229,229,229,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,257.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,257.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,265.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,257.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,538.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,272.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,229,229,229,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,257.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,272.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,556.22,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,262.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,257.45,556.22,,facility
CYSTO W/URETER STRICTURE TX,52341,CPT,761,RC,,,,outpatient,,,9704,970.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1027,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1519,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3373.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3373.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3474.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3373.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,7050.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3576.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3373.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3576.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,3441.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,7050.84,,facility
FLOWCYTOMETRY/ TC 1 MARKER,88184,CPT,311,RC,,,,outpatient,,,710,71,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,315.62,315.62,343.05,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,546.56,546.56,731.52,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,343.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,343.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,353.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,286.94,286.94,384.05,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,343.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,716.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,363.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,179.34,179.34,179.34,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,63.07,63.07,165.15,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,343.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,363.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,377,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,349.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,343.05,716.97,,facility
IMMUNOASSAY QUANT NOS NONAB,83520,CPT,301,RC,,,,outpatient,,,545,54.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,36,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,66.08,66.08,66.08,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,41.18,24.82,318.38,1 through 10,percent of total billed charges,,,33.6,,37.63,37.63,96.43,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,33.6,23.18,176.4,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,36.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,87,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.22,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.27,448,,facility
SYPHILIS DETECTION TEST,86592,CPT,0302,RC,,,,outpatient,,,135,13.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.8,3.8,3.8,262,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,28.8,3.16,28.8,20,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,26.55,26.4,79.65,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,28.8,28.8,28.8,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,23.76,15.12,23.76,39,percent of total billed charges,,,33.6,,15.17,15.12,45.36,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,15.12,15.12,15.17,34,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,8.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,22.38,22.38,22.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.8,3.8,3.8,282,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.22,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,4.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,4.27,448,,facility
PREPARATION OF SPECIMEN; MANUAL,88381,CPT,0310,RC,,,,outpatient,,,630,63,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,93.74,93.74,93.74,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,21.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,44.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,21.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,172.62,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,21.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,21.51,448,,facility
CULTURE SCREEN ONLY,87081,CPT,306,RC,,,,outpatient,,,920,92,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.9,5.9,5.9,191,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,192.64,5.9,192.64,17,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,277.89,277.89,277.89,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,148.9,101.14,158.93,15,percent of total billed charges,,,33.6,,148.9,101.14,158.93,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,101.14,95.6,101.14,34,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,13.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,7.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,150.5,141,150.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,63.21,63.21,63.21,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.9,5.9,5.9,279,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,7.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.32,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,6.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,6.63,448,,facility
DETECTION TEST BY NUCLEIC ACID FOR MYCOPLASMA PNEUMONIAE (BACTERIA); AMPLIFIED PROBE TECHNIQUE,87581,CPT,0306,RC,,,,outpatient,,,948,94.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
DETECT AGENT NOS DNA AMP,87798,CPT,306,RC,,,,outpatient,,,525,52.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,110.88,110.88,174.24,1 through 10,percent of total billed charges,,,33.6,,244.27,244.27,244.27,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,96.77,32.38,119.79,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,38.9,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
FOOT SINGLE AXIS ANKLE/FOOT,L5974,HCPCS,274,RC,,,,outpatient,,,482,48.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,66,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,61,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,324.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,324.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,334.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,324.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,678.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,343.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,324.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,343.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,331.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,324.52,678.25,,facility
NOVACHOR 1 SQ CM,Q4194,HCPCS,636,RC,,,,outpatient,,,2386,238.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,126.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,126.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,130.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,126.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,264.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,134.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,126.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,134.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,129.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,126.52,448,,facility
CLOSED TREATMENT OF BROKEN OR GROWTH PLATE SEPARATE OF FOREARM BONE AT WRIST WITH MANIPULATION,25605,CPT,0450,RC,,,,outpatient,,,3948,394.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1027,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1519,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1585.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3216.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1631.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,1425.19,1425.19,1448,21,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1631.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1569.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3216.38,,facility
TRB@ GENE REARRANGE AMPLIFY,81340,CPT,310,RC,,,,outpatient,,,485,48.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,185.83,185.83,185.83,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,208.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,208.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,215.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,208.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,436.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,221.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,208.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,221.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,451.36,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,213.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,208.92,451.36,,facility
COMPLETE SINGLE SESSION COURSE OF CRANIAL LESION SURGERY USING RADIATION AND A MACHINE TO DELIVER EXTERNAL RADIATION,77372,CPT,0333,RC,,,,outpatient,,,17638,1763.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,6707.31,6707.31,6707.31,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7049.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7049.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7260.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,7049.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,14732.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,7471.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,6807.53,6807.53,6807.53,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,7049.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,7471.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,48815,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,7189.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,48815,,facility
INSITU HYBRIDIZATION (FISH),88365,CPT,310,RC,,,,outpatient,,,480,48,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,163,163,163,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,167.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,169.34,169.34,266.11,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,340.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,172.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,252,252,252,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,107.35,107.35,339.75,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,172.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,226.07,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,166.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,163.06,448,,facility
CARDIOLIPIN ANTIBODY EA IG,86147,CPT,302,RC,,,,outpatient,,,352,35.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,22.64,22.64,22.64,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,72.86,42.34,163.68,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,50.06,50.06,137.76,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,25.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,53.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,26.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,22.64,22.64,22.64,31,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,25.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,26.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,54.99,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,25.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,25.45,448,,facility
RIA NONANTIBODY,83519,CPT,301,RC,,,,outpatient,,,780,78,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,55.44,55.44,55.44,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.37,16.37,16.37,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.2,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.4,448,,facility
IMMUNOASSAY INFECTIOUS AGENT,86317,CPT,302,RC,,,,outpatient,,,226,22.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.33,13.33,13.33,86,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,59,59,59,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,52.8,26.54,52.8,41,percent of total billed charges,,,33.6,,52.8,33.6,52.8,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,33.6,33.6,33.73,52,percent of total billed charges,,,34.6,,218.53,218.53,218.53,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,31.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,50,50,50,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.33,13.33,13.33,209,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.38,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,15.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.99,448,,facility
ASSAY OF AMYLASE,82150,CPT,301,RC,,,,outpatient,,,41,4.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.76,5.76,5.76,19,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,95,95,95,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,54.24,31.92,54.25,46,percent of total billed charges,,,33.6,,31.92,27.12,54.24,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,31.92,27.12,31.92,11,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,13.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,40,40,47.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.76,5.76,5.76,306,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,6.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,6.48,448,,facility
FXN GENE FULL GENE SEQUENCE,81286,CPT,310,RC,,,,outpatient,,,235,23.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,274.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,274.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,283.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,274.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,574.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,291.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,274.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,291.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,480.95,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,280.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,274.83,574.39,,facility
ASSAY OF CALCITONIN,82308,CPT,301,RC,,,,outpatient,,,280,28,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,23.83,23.83,23.83,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,26.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,55.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,28.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,23.83,23.83,23.83,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,26.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,28.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,57.89,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,27.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,26.79,448,,facility
THROMBOPLASTIN TIME PARTIAL,85730,CPT,305,RC,,,,outpatient,,,102,10.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.35,5.35,5.35,44,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,17.28,17.28,226.56,25,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,208.86,15.93,208.86,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,186.91,11.69,202.13,44,percent of total billed charges,,,33.6,,118.94,9.07,237.89,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,118.94,9.07,120.01,25,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,12.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,177,13.5,177,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.35,5.35,5.35,310,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.99,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,6.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,6.01,448,,facility
QUANTITATIVE ASSAY DRUG,80299,CPT,301,RC,,,,outpatient,,,105,10.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,13,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,174.64,174.64,174.64,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,171.6,171.6,171.6,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,374.52,374.52,374.52,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.62,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.64,448,,facility
X-RAY OF SHOULDER BLADE,73010,CPT,0320,RC,,,,outpatient,,,926,92.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.39,12.39,12.39,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,448,,facility
HISTOPLASMA ANTIBODY,86698,CPT,302,RC,,,,outpatient,,,59,5.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.27,12.27,12.27,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,28.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.27,12.27,12.27,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.79,448,,facility
COAGULATION ASSESSMENT BLOOD TEST; PLASMA OR WHOLE BLOOD,85730,CPT,0305,RC,,,,outpatient,,,354,35.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.35,5.35,5.35,44,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,17.28,17.28,226.56,25,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,208.86,15.93,208.86,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,186.91,11.69,202.13,44,percent of total billed charges,,,33.6,,118.94,9.07,237.89,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,118.94,9.07,120.01,25,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,12.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,177,13.5,177,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.35,5.35,5.35,310,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.99,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,6.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,6.01,448,,facility
PHENOTYPE INFECT AGENT DRUG,87900,CPT,306,RC,,,,outpatient,,,333,33.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,130.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,130.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,134.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,130.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,272.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,138.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,130.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,138.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,281.61,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,132.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,130.35,448,,facility
PROTHROMBIN TIME,85610,CPT,305,RC,,,,outpatient,,,40,4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.82,3.82,3.82,148,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,25.6,25.6,68.48,85,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,63.13,63.13,63.13,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,35.95,16.37,61.1,101,percent of total billed charges,,,33.6,,21.12,13.44,56.5,20,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,13.56,13.44,36.27,76,percent of total billed charges,,,34.6,,38.84,38.84,40.77,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,8.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,53.5,20,141,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,22.47,8.4,22.47,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.82,3.82,3.82,801,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.49,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,4.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,4.29,448,,facility
SMEAR FOR PARASITES,87177,CPT,0306,RC,,,,outpatient,,,95,9.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,7.92,7.92,7.92,19,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,60.8,60.8,205.44,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,50.16,31.92,50.16,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,31.92,31.92,31.92,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,18.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,9.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,7.92,7.92,7.92,21,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,9.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.23,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,9.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,8.9,448,,facility
MOPATH PROCEDURE LEVEL 4,81403,CPT,310,RC,,,,outpatient,,,605,60.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,185.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,185.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,190.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,322.39,322.39,322.39,1 through 10,percent of total billed charges,,,34.6,,397.12,397.12,397.12,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,185.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,387.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,196.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,185.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,196.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,324.1,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,188.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,185.2,448,,facility
COAGULATION TIME ACTIVATED,85347,CPT,305,RC,,,,outpatient,,,295,29.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,57.12,38.17,224.4,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,8.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.81,3.81,3.81,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.21,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,4.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,4.28,448,,facility
X-RAY OF LOWER JAWS; UPPER JAWS AND TEETH,70355,CPT,0320,RC,,,,outpatient,,,501,50.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,85.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,174.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,84.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,83.29,448,,facility
CHIMERISM ANAL W/CELL SELECT,81268,CPT,310,RC,,,,outpatient,,,450,45,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,231.97,231.97,231.97,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,2152.96,2152.96,2152.96,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,260.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,260.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,268.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,653.4,653.4,685.8,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,1130.3,495.96,1221.13,22,percent of total billed charges,,,34.6,,1221.13,1221.13,2354.8,12,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,260.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,545.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,276.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,231.97,231.97,231.97,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,260.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,276.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,563.43,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,266.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,260.79,563.43,,facility
GROUP THERAPEUTIC PROCEDURES,97150,CPT,430,RC,,,,outpatient,,,322,32.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,51.96,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,89.84,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,80,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,35.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,422,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.1,448,,facility
SMEAR FLUORESCENT/ACID STAI,87206,CPT,306,RC,,,,outpatient,,,107,10.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.79,4.79,4.79,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,11.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.79,4.79,4.79,21,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.64,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.39,448,,facility
EXOSKELETAL BK ULTRALT MATER,L5785,HCPCS,274,RC,,,,outpatient,,,1044,104.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,66,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,61,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,709.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,709.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,730.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,709.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1482.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,751.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,709.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,751.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,723.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,709.19,1482.21,,facility
INSERTION OF TUBE IN RIGHT HEART CHAMBERS AND CORONARY ARTERY FOR DIAGNOSIS WITH REVIEW BY RADIOLOGIST,93456,CPT,0480,RC,,,,outpatient,,,24485,2448.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2004,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,2759,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 6500.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 10000.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,3102.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3102.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3195.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3102.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,6484.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3288.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3102.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3288.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1463,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,3164.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,1463,6484.66,,facility
"INJ RUXIENCE, 10 MG",Q5119,HCPCS,636,RC,,,,outpatient,,,176,17.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,16.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,9292.8,9292.8,9292.8,300,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,33.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,50.72,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,16.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,16.16,448,,facility
INFUSION INTO A VEIN FOR THERAPY; PREVENTION; OR DIAGNOSIS; 1 HOUR OR LESS,96365,CPT,0260,RC,,,,outpatient,,,478,47.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,184.86,173.06,191.54,360,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,397.44,366.39,397.44,46,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,366.39,187.62,366.39,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,203.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,203.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,209.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,327.89,208.66,327.89,47,percent of total billed charges,,,33.6,,327.89,208.66,327.89,45,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,208.66,162.04,208.66,40,percent of total billed charges,,,34.6,,225.42,225.42,225.42,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,203.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,425.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,215.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,130.41,100.38,130.41,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,187.62,187.62,191.54,327,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,203.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,215.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,427,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,207.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,203.57,448,,facility
DETECT AGNT MULT DNA AMPLI,87801,CPT,306,RC,,,,outpatient,,,451,45.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,70.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,70.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,72.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,70.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,146.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,74.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,62.44,62.44,62.44,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,70.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,74.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,151.66,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,71.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,70.2,448,,facility
X-RAY OF ENTIRE MIDDLE AND LOWER SPINE; 4-5 VIEWS,72083,CPT,0320,RC,,,,outpatient,,,1613,161.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,1037.44,1037.44,1037.44,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,448,,facility
DETECT AGENT NOS DNA AMP,87798,CPT,306,RC,,,,outpatient,,,599,59.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,110.88,110.88,174.24,1 through 10,percent of total billed charges,,,33.6,,244.27,244.27,244.27,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,96.77,32.38,119.79,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,38.9,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
"INJ, TEBENTAFUSP-TEBN, 1 MCG",J9274,HCPCS,636,RC,,,,outpatient,,,828,82.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,228.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,228.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,234.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,228.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,476.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,241.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,228.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,241.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,461.73,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,232.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,228.01,476.54,,facility
DOUBLE CONTRAST X-RAY OF UPPER DIGESTIVE TRACT,74246,CPT,0320,RC,,,,outpatient,,,1985,198.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,172.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,350.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,177.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,177.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,171.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,167.87,448,,facility
CHROMOSOME ANALYSIS 20-25,88264,CPT,311,RC,,,,outpatient,,,444,44.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,144.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,144.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,148.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,144.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,302.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,153.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,144.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,153.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,269.29,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,147.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,144.61,448,,facility
"INJECTION, FAMOTIDINE, 20 MG",S0028,HCPCS,636,RC,,,,outpatient,,,4,0.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 103.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment.",,,,0,other,"Payer contract is 103.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment. + No services performed during 15-month lookback period",,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment. + No services performed during 15-month lookback period",,,"Payer contract is 209.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment.",,,,0,other,"Payer contract is 209.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment. + No services performed during 15-month lookback period",,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment. + No services performed during 15-month lookback period",,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 102.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment.",,,,0,other,"Payer contract is 102.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment. + No services performed during 15-month lookback period",448,448,,facility
CAST SUP SHT LEG SPLNT FBRGL,Q4046,HCPCS,270,RC,,,,outpatient,,,61,6.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,23.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,23.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,23.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,49.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,25.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,23.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,25.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,24.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,23.79,448,,facility
BIOPSY OF LARGE BOWEL USING AN ENDOSCOPE INSERTED THROUGH SURGICALLY CREATED OPENING FROM LARGE BOWEL TO SKIN,44389,CPT,0750,RC,,,,outpatient,,,5360,536,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1179.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,2393.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1213.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1213.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3821,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1168.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3821,,facility
PATHOLOGY EXAMINATION OF TISSUE USING A MICROSCOPE; HIGH COMPLEXITY,88309,CPT,0310,RC,,,,outpatient,,,2042,204.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,771.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,771.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,794.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,686.11,686.11,916.86,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,686.11,686.11,696.33,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,771.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1611.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,817.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,1021,1021,1021,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,428.82,428.82,428.82,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,233.59,233.59,244.28,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,771.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,817.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,946.68,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,786.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1611.56,,facility
FRESH FROZEN PLASMA BETWEEN 8-24 HOURS OF COLLECTION; EACH UNIT,P9059,HCPCS,0390,RC,,,,outpatient,,,855,85.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,65.57,65.57,65.57,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,73.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,73.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,579.69,579.69,579.69,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,73.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,153.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,77.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,122.32,122.32,183.48,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,73.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,77.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,107,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,74.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,73.41,448,,facility
IMMUNOASSAY NONANTIBODY,83516,CPT,301,RC,,,,outpatient,,,1068,106.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9,9,10.26,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,4.75,4.75,218.59,30,percent of total billed charges,,,33.6,,3.02,3.02,175.39,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,3.02,3.02,211.68,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,24.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,23.5,23.5,23.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9,9,10.26,51,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.92,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,11.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.53,448,,facility
RUBEOLA ANTIBODY,86765,CPT,302,RC,,,,outpatient,,,243,24.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.46,11.46,11.46,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,22.18,22.18,83.95,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,20.68,20.68,20.68,1 through 10,percent of total billed charges,,,34.6,,61.35,61.35,61.35,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,26.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,44,44,44,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.46,11.46,11.46,18,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.88,448,,facility
ANTITHROMBIN III ANTIGEN (CLOTTING INHIBITOR) ACTIVITY,85300,CPT,0305,RC,,,,outpatient,,,209,20.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.54,10.54,10.54,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,38.54,24.53,38.54,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,24.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.54,10.54,10.54,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.6,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.85,448,,facility
CANCER CYTOGENOMIC ARRAY GENE ANALYSIS,81277,CPT,0310,RC,,,,outpatient,,,8667,866.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1160,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1160,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1194.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,3279.09,3279.09,3279.09,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1160,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,2424.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1229.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,975.94,975.94,1031.8,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1160,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1229.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2030,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1183.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,2424.4,,facility
ASSAY OF NOS VITAMIN,84591,CPT,301,RC,,,,outpatient,,,120,12,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,35.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.86,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.06,448,,facility
ORGANIC ACID SINGLE QUANT,83921,CPT,301,RC,,,,outpatient,,,150,15,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,18.87,18.87,18.87,11,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,60.72,38.64,203.28,1 through 10,percent of total billed charges,,,33.6,,129.36,129.36,129.36,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,38.64,38.64,38.9,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,21.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,44.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,57.38,57.38,57.38,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,18.87,18.87,18.87,21,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,21.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,37.12,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,21.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,21.21,448,,facility
REMOVAL OF FLUID FROM BETWEEN LUNG AND CHEST CAVITY,32551,CPT,0450,RC,,,,outpatient,,,2910,291,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1506.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1506.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1551.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1506.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3148.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1596.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1506.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1596.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1536.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3148.69,,facility
DETECT AGNT MULT DNA AMPLI,87801,CPT,306,RC,,,,outpatient,,,1468,146.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,70.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,70.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,72.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,70.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,146.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,74.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,62.44,62.44,62.44,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,70.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,74.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,151.66,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,71.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,70.2,448,,facility
SIMPLE RADIATION THERAPY PLANNING FOR DELIVERY OF INTERNAL RADIATION,77316,CPT,0333,RC,,,,outpatient,,,1140,114,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,358.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,358.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,369.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,358.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,748.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,379.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,358.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,379.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,48815,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,365.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,358.36,48815,,facility
ASSAY OF PREALBUMIN,84134,CPT,301,RC,,,,outpatient,,,292,29.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.98,12.98,12.98,37,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,47.52,47.52,166.73,1 through 10,percent of total billed charges,,,33.6,,98.11,98.11,98.11,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,30.24,30.24,98.99,16,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,30.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,18.9,18.9,18.9,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.98,12.98,12.98,128,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,31.52,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.59,448,,facility
REMOVAL OF BLOOD ACCUMULATION UNDER FINGERNAIL OR TOENAIL,11740,CPT,0450,RC,,,,outpatient,,,1742,174.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,131.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,266.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,134.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,114.79,114.79,114.79,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,134.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,129.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,127.33,1173,,facility
EVALUATION OF FINE NEEDLE ASPIRATE,88172,CPT,0311,RC,,,,outpatient,,,495,49.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,150.35,150.35,163,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,316.8,316.8,316.8,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,167.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,261.36,166.32,522.72,1 through 10,percent of total billed charges,,,33.6,,166.32,166.32,166.32,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,166.32,166.32,167.81,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,340.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,172.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,17.79,17.79,17.79,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,172.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,226.07,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,166.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,163.06,448,,facility
IMMUNOASSAY NONANTIBODY,83516,CPT,301,RC,,,,outpatient,,,684,68.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9,9,10.26,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,4.75,4.75,218.59,30,percent of total billed charges,,,33.6,,3.02,3.02,175.39,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,3.02,3.02,211.68,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,24.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,23.5,23.5,23.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9,9,10.26,51,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.92,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,11.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.53,448,,facility
CHLMYD TRACH DNA AMP PROBE,87491,CPT,306,RC,,,,outpatient,,,43,4.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,442,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,20.65,20.65,65.49,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,232.32,232.32,232.32,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,37.3,18.48,58.61,62,percent of total billed charges,,,33.6,,37.3,11.76,63.38,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,28.82,11.76,37.3,69,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,42.5,17.5,55.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,23.31,23.31,23.31,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,31.21,31.21,31.21,1 through 10,percent of total billed charges,,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,796,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
MOPATH PROCEDURE LEVEL 2,81401,CPT,310,RC,,,,outpatient,,,1064,106.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,121.86,121.86,121.86,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,137,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,137,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,141.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,137,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,286.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,145.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,137,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,145.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,239.75,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,139.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,137,448,,facility
INSERT NEEDLE BONE CAVITY,36680,CPT,761,RC,,,,outpatient,,,2910,291,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,427.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,427.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,440.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,427.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,893.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,453.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,427.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,453.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,436.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,427.54,1173,,facility
PROTEIN WESTERN BLOT TEST,84182,CPT,301,RC,,,,outpatient,,,825,82.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,217.54,217.54,217.54,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,29.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,61.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,30.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,25.98,25.98,25.98,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,29.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,30.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,51.12,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,29.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,29.21,448,,facility
ULTRASOUND SCAN OF TRANSPLANTED KIDNEY,76776,CPT,0402,RC,,,,outpatient,,,2370,237,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,93.3,93.3,93.3,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,465,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,465,,facility
CYTOMEG DNA QUANT,87497,CPT,306,RC,,,,outpatient,,,400,40,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,38.11,38.11,38.11,50,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,44.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,385.19,152.4,747.39,1 through 10,percent of total billed charges,,,33.6,,339.7,339.7,533.81,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,385.19,342.73,385.19,14,percent of total billed charges,,,34.6,,385.19,366.99,385.19,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,89.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,45.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,212.31,212.31,212.31,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,38.11,38.11,38.11,203,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,45.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,92.54,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,43.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,42.84,448,,facility
ASPIRATION OF FLUID FROM CHEST CAVITY USING IMAGING GUIDANCE,32555,CPT,0360,RC,,,,outpatient,,,2914,291.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,600.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,600.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,618.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,1445.78,1445.78,1445.78,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,600.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1254.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,636.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,600.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,636.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2712,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,612.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,2712,,facility
COLL VENOUS BLD VENIPUNCTURE,36415,CPT,300,RC,,,,outpatient,,,90,9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,8.09,8.09,8.31,58,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,10.91,9.28,57.6,227,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,12.73,8.56,79.9,21,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,90,90,90,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,51.39,30.24,51.39,230,percent of total billed charges,,,33.6,,30.24,5.04,51.39,24,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,30.24,30.24,30.51,106,percent of total billed charges,,,34.6,,32.69,32.69,32.69,1 through 10,percent of total billed charges,,,45,,8.09,8.09,8.09,1 through 10,percent of total billed charges,,9.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,19.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,9.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,7.5,7.25,45,119,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,18.9,3.15,18.9,49,percent of total billed charges,,,35,,45,45,45,1 through 10,percent of total billed charges,,,40,,15,8.09,90,1 through 10,percent of total billed charges,,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,8.09,8.09,8.31,11157,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,9.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,9.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.25,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,9.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.25,448,,facility
RBC LEUKOREDUCED IRRADIATED,P9040,HCPCS,390,RC,,,,outpatient,,,550,55,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,235.95,235.95,264.11,49,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,1502.72,1502.72,3005.44,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,264.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,264.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,272.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,1239.74,788.93,2479.49,1 through 10,percent of total billed charges,,,33.6,,788.93,788.93,1340.71,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,894.59,852.32,894.59,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,264.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,551.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,279.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,493.08,493.08,493.08,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,169.4,169.4,169.4,35,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,264.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,279.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,107,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,269.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,107,551.99,,facility
CANDIDA DNA DIR PROBE,87480,CPT,306,RC,,,,outpatient,,,132,13.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,20.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,41.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,21.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,20.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,21.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,43.33,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,20.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,20.05,448,,facility
CELL FUNCTION ASSAY W/STIM,86352,CPT,302,RC,,,,outpatient,,,72,7.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,135.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,135.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,139.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,210.52,210.52,210.52,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,135.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,283.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,144.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,120.85,120.85,120.85,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,135.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,144.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,293.53,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,138.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,135.86,448,,facility
UNLISTED MOLECULAR PATHOLOGY,81479,CPT,310,RC,,,,outpatient,,,3540,354,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,561.56,561.56,561.56,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,32.5,32.5,3071.5,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
"DARBEPOETIN ALFA, NON-ESRD",J0881,HCPCS,636,RC,,,,outpatient,,,36,3.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,2.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,6.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.39,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,2.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,2.92,448,,facility
GENE ANALYSIS (CYSTIC FIBROSIS TRANSMEMBRANE CONDUCTANCE REGULAR) COMMON VARIANTS,81220,CPT,0310,RC,,,,outpatient,,,3553,355.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,495.09,495.09,495.09,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,556.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,556.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,573.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,1875.98,1875.98,1875.98,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,1193.81,1193.81,1204.47,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,556.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1163.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,590,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,495.09,495.09,495.09,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,556.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,590,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,974.05,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,567.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1163.29,,facility
CONCENTRATION OF SPECIMEN FOR INFECTIOUS AGENTS,87015,CPT,0306,RC,,,,outpatient,,,96,9.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.94,5.94,5.94,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,13.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,7.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.94,5.94,5.94,23,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,7.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.42,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,6.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,6.68,448,,facility
ASSAY PH BODY FLUID NOS,83986,CPT,301,RC,,,,outpatient,,,160,16,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.18,3.18,3.18,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,75.43,75.43,75.43,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,7.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.18,3.18,3.18,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.74,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,3.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,3.58,448,,facility
COMPLICATED REPAIR OF WOUND OF SCALP; ARMS; OR LEGS; EACH ADDITIONAL 5.0 CM OR LESS,13122,CPT,0450,RC,,,,outpatient,,,1641,164.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,64.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,64.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,66.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,64.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,135.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,68.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,64.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,68.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,66.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,64.74,1173,,facility
ABOVE KNEE MANUAL LOCK,L5925,HCPCS,274,RC,,,,outpatient,,,814,81.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,66,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,61,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,548.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,548.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,564.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,548.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1146.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,581.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,548.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,581.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,559.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,548.48,1146.32,,facility
HEXAGNAL PHOSPH PLTLT NEUTRL,85598,CPT,305,RC,,,,outpatient,,,155,15.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.99,15.99,15.99,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,168.32,168.32,168.32,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,37.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.98,448,,facility
ULTRASOUND SCAN OF ORGAN TISSUE FOR MEASURING ELASTICITY,76981,CPT,0402,RC,,,,outpatient,,,547,54.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,402.56,402.56,402.56,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,282.42,282.42,282.42,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,62.56,62.56,62.56,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,465,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,465,,facility
ELECTROLYTE PANEL,80051,CPT,301,RC,,,,outpatient,,,37,3.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,6.24,6.24,6.24,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,154.46,116.62,226.12,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,133.06,133.06,133.06,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,7.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,14.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,7.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,6.24,6.24,6.24,15,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,7.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,7.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.16,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,7.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,7.01,448,,facility
WHITE BLOOD CELL ANTIGEN MEASUREMENT,86356,CPT,0302,RC,,,,outpatient,,,105,10.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,23.82,23.82,23.82,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,138.06,138.06,552.24,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,464.64,464.64,464.64,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,26.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,55.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,28.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,23.82,23.82,23.82,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,26.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,28.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,57.86,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,27.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,26.78,448,,facility
AFO PLASTIC MOLDED W/ANKLE J,L1970,HCPCS,274,RC,,,,outpatient,,,1213,121.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,66,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,61,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,817.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,817.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,842.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,817.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1708.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,866.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,817.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,866.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,834.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,817.68,1708.95,,facility
FIBRINOGEN ACTIVITY,85384,CPT,305,RC,,,,outpatient,,,287,28.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,8.65,8.65,8.65,24,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,35.38,22.51,262.09,12,percent of total billed charges,,,33.6,,35.38,22.51,154.22,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,154.22,154.22,311.2,1 through 10,percent of total billed charges,,,34.6,,169.83,169.83,169.83,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,9.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,20.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,33.5,33.5,33.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,8.65,8.65,8.65,96,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,9.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.36,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,9.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,9.72,448,,facility
ULTRASOUND SCAN OF FETAL HEART,76825,CPT,0402,RC,,,,outpatient,,,4294,429.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,3160.32,3160.32,3160.32,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,522.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,522.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,538.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,2607.26,2607.26,5214.53,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,522.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1092.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,554.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,522.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,554.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,465,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,533.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1092.97,,facility
IMMUNOASSAY QUANT NOS NONAB,83520,CPT,301,RC,,,,outpatient,,,780,78,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,36,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,66.08,66.08,66.08,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,41.18,24.82,318.38,1 through 10,percent of total billed charges,,,33.6,,37.63,37.63,96.43,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,33.6,23.18,176.4,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,36.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,87,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.22,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.27,448,,facility
CT SCAN OF CHEST WITHOUT CONTRAST,71250,CPT,0352,RC,,,,outpatient,,,5057,505.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,93.3,92.3,101.15,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,403,,,,,,,case rate,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,371,,,,,,,case rate,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,411,411,411,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,73,,411,378,3691.61,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,875,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1050,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,2670.1,1699.15,2887.55,17,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,1699.15,1699.15,1714.32,12,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,2528.5,2528.5,2528.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,1061.97,1061.97,1061.97,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,68.25,68.25,71.34,33,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1522,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,1522,,facility
DRUG/SUBSTANCE NOS 4-6,80376,CPT,301,RC,,,,outpatient,,,653,65.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
"INJ, FYLNETRA, 0.5 MG",Q5130,HCPCS,636,RC,,,,outpatient,,,875,87.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,105.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,105.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,108.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,105.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,219.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,111.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,105.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,111.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,394.57,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,107.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,105.11,448,,facility
TEST SOCKET BELOW KNEE,L5620,HCPCS,274,RC,,,,outpatient,,,675,67.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,66,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,61,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,453.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,453.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,467.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,453.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,948.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,481.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,453.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,481.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,462.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,453.81,948.46,,facility
REMOVAL OF TISSUE LINING OF ESOPHAGUS; STOMACH; AND/OR UPPER SMALL BOWEL USING A FLEXIBLE ENDOSCOPE,43254,CPT,0750,RC,,,,outpatient,,,7837,783.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,1664.42,1664.42,1664.42,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,1027,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1519,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,1836.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1836.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1891.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,4171.19,4171.19,4171.19,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1836.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3838.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1946.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1836.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1946.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3821,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1873.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3838.31,,facility
MOPATH PROCEDURE LEVEL 6,81405,CPT,310,RC,,,,outpatient,,,201,20.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,301.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,301.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,310.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,301.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,629.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,319.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,301.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,319.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,527.36,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,307.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,301.35,629.82,,facility
IMMUNOASSAY QUANT NOS NONAB,83520,CPT,301,RC,,,,outpatient,,,375,37.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,36,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,66.08,66.08,66.08,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,41.18,24.82,318.38,1 through 10,percent of total billed charges,,,33.6,,37.63,37.63,96.43,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,33.6,23.18,176.4,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,36.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,87,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.22,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.27,448,,facility
ASSAY OF GONADOTROPIN (FSH),83001,CPT,301,RC,,,,outpatient,,,249,24.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.53,16.53,16.53,63,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,146.91,146.91,146.91,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,35.38,22.51,35.38,22,percent of total billed charges,,,33.6,,35.38,35.38,131.47,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,22.51,22.51,83.66,27,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,33.5,33.5,33.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,14.07,14.07,14.07,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.53,16.53,16.53,116,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,40.15,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.58,448,,facility
DIAGNOSTIC EXAM OF SURGICALLY CREATED POUCH OF SMALL BOWEL USING AN ENDOSCOPE,44385,CPT,0750,RC,,,,outpatient,,,3740,374,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,890.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,890.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,916.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,890.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1860.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,943.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,811.89,0.28,837.43,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,890.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,943.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3821,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,907.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3821,,facility
"INJ, CALCIUM GLUCONATE, NOS",J0612,HCPCS,636,RC,,,,outpatient,,,0.42,0.04,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",448,448,,facility
ENCEPHALTIS EAST EQNE ANBDY,86652,CPT,302,RC,,,,outpatient,,,130,13,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.49,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.19,448,,facility
ASSAY OF VOLATILES,84600,CPT,301,RC,,,,outpatient,,,286,28.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,35.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,34.74,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.11,448,,facility
ASSAY OF CREATINE,82540,CPT,301,RC,,,,outpatient,,,66,6.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,9.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.01,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,4.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,4.64,448,,facility
DRUG SCREENING OXYCODONE,80365,CPT,301,RC,,,,outpatient,,,105,10.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
INJECTION INTO SKIN GROWTH; MORE THAN 7 GROWTHS,11901,CPT,0761,RC,,,,outpatient,,,1584,158.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,197.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,401.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,203.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,1584,1584,1584,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,203.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,195.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,192.01,1173,,facility
ULTRASOUND SCAN OF SPINAL CANAL,76800,CPT,0402,RC,,,,outpatient,,,2041,204.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,1502.08,1306.24,1502.08,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,1384.73,1384.73,1384.73,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,1239.22,788.59,1239.22,1 through 10,percent of total billed charges,,,33.6,,788.59,788.59,788.59,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,788.59,788.59,788.59,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,465,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,465,,facility
CONSLTJ&REPRT MATRL PREP SLD,88323,CPT,312,RC,,,,outpatient,,,73,7.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,46.88,46,49.87,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,48.87,48.87,211.2,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,49.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,49.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,51.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,49.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,104.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,52.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,24.26,24.26,24.26,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,49.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,52.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,78.23,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,50.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,49.87,448,,facility
ENDO AK/HIP ALIGNABLE SYSTEM,L5920,HCPCS,274,RC,,,,outpatient,,,1287,128.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,66,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,61,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,866.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,866.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,892.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,866.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1810.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,918.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,866.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,918.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,883.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,866.11,1810.17,,facility
HEP B CORE ANTIBODY TOTAL,86704,CPT,302,RC,,,,outpatient,,,866,86.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.72,10.72,10.72,67,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,71.68,71.68,83.84,35,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,66.08,66.08,66.08,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,59.14,37.63,59.14,29,percent of total billed charges,,,33.6,,59.14,37.63,59.14,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,37.63,37.63,37.97,41,percent of total billed charges,,,34.6,,38.48,13.53,47.55,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,56,56,56,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.72,10.72,10.72,161,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.04,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.05,448,,facility
MEASUREMENT OF LEFLUNOMIDE,80193,CPT,0301,RC,,,,outpatient,,,250,25,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,39.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,38.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,80.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,40.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,38.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,40.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,67.5,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,39.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,38.57,448,,facility
MYCOPLASMA,87109,CPT,306,RC,,,,outpatient,,,201,20.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.69,13.69,13.69,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,32.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.69,13.69,13.69,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,33.25,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,15.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,15.39,448,,facility
OTHER ULTRASOUND PROCEDURE,76999,CPT,0400,RC,,,,outpatient,,,283,28.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,235.52,235.52,235.52,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,85.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,174.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,197,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,84.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,83.29,448,,facility
TRB@ GENE REARRANGE AMPLIFY,81340,CPT,310,RC,,,,outpatient,,,1981,198.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,185.83,185.83,185.83,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,208.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,208.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,215.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,208.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,436.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,221.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,208.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,221.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,451.36,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,213.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,208.92,451.36,,facility
CCP ANTIBODY,86200,CPT,302,RC,,,,outpatient,,,387,38.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.52,11.52,11.52,14,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,70.8,70.8,70.8,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,63.36,25.87,63.36,1 through 10,percent of total billed charges,,,33.6,,40.32,40.32,63.36,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,33.26,16.46,40.68,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.52,11.52,11.52,56,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.97,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.95,448,,facility
X-RAY OF PELVIS; MINIMUM OF 3 VIEWS,72190,CPT,0320,RC,,,,outpatient,,,1059,105.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,677.76,677.76,677.76,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,559.15,559.15,559.15,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,355.82,355.82,359,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,448,,facility
NUCLEAR ANTIGEN ANTIBODY,86235,CPT,302,RC,,,,outpatient,,,276,27.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13,12.5,15.95,11,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,54.91,4.37,90.29,43,percent of total billed charges,,,33.6,,4.37,4.37,53.09,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,22.18,4.24,83.33,13,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,37.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.95,13,15.95,54,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.75,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.93,448,,facility
CLOSED TREATMENT OF BROKEN TOP OF UPPER ARM BONE WITH MANIPULATION,23605,CPT,0450,RC,,,,outpatient,,,3201,320.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1585.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3216.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1631.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1631.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1569.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3216.38,,facility
INSERTION OF TUBE IN LEFT HEART CHAMBER THROUGH HEART SEPTUM,93462,CPT,0480,RC,,,,outpatient,,,18105,1810.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 6500.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 10000.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,167.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,167.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,172.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,167.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,350.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,177.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,178.89,173.88,178.89,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,167.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,177.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1463,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,171.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,167.76,1463,,facility
HYDROCORTISONE SODIUM SUCC I,J1720,HCPCS,636,RC,,,,outpatient,,,138,13.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,66.72,66.72,66.72,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,52.8,,59.53,59.53,59.53,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,32.63,32.63,32.63,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,21.89,21.89,21.89,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",448,448,,facility
BLOOD TEST; THYROID STIMULATING HORMONE (TSH),84443,CPT,0301,RC,,,,outpatient,,,474,47.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,14.94,14.94,14.94,707,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,50.15,50.15,279.66,31,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,44.88,28.56,250.27,227,percent of total billed charges,,,33.6,,44.88,28.56,250.27,59,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,28.56,28.56,159.26,382,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,35.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,42.5,42.25,237,16,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,17.85,17.85,99.54,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,14.94,14.94,14.94,1704,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.31,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,16.8,448,,facility
ASSAY OF UREA NITROGEN,84520,CPT,301,RC,,,,outpatient,,,18,1.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.51,3.51,3.51,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,7.9,7.9,7.9,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,37.69,22.18,37.69,1 through 10,percent of total billed charges,,,33.6,,22.18,22.18,22.18,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,22.18,19.49,43.73,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,8.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.51,3.51,3.51,46,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.54,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,4.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,3.95,448,,facility
THYROXINE (THYROID CHEMICAL); FREE,84439,CPT,0301,RC,,,,outpatient,,,524,52.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,8.02,8.02,8.02,335,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,53.1,53.1,309.16,13,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,47.52,30.24,276.67,112,percent of total billed charges,,,33.6,,47.52,30.24,276.67,25,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,30.24,30.24,176.06,119,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,9.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,18.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,9.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,45.13,45,262,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,18.9,18.9,18.9,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,8.02,8.02,8.02,954,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,9.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,9.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.48,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,9.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,9.02,448,,facility
INJ OGIVRI 10 MG,Q5114,HCPCS,636,RC,,,,outpatient,,,212,21.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,7022.62,2022.72,7022.62,210,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,31.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,31.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,5821.31,4477.44,7623.3,391,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,3722.25,3449.66,5186.26,1107,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,31.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,66.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,33.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,31.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,33.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,111.46,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,32.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,31.94,448,,facility
BLOOD GASES MEASUREMENT; WITH O2 SATURATION,82805,CPT,0301,RC,,,,outpatient,,,466,46.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,78.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,78.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,81.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,156.58,156.58,266.09,1 through 10,percent of total billed charges,,,33.6,,188.4,188.4,188.4,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,156.58,156.58,156.58,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,78.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,164.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,83.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,70.06,70.06,70.06,25,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,78.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,83.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,137.85,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,80.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,78.77,448,,facility
ASSAY OF PARATHORMONE,83970,CPT,301,RC,,,,outpatient,,,462,46.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,36.72,36.72,36.72,87,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,67.85,67.85,67.85,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,41.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,41.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,60.72,38.64,209.62,23,percent of total billed charges,,,33.6,,38.64,38.64,38.64,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,38.99,38.64,134.58,39,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,41.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,86.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,43.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,83.37,83.37,83.37,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,36.72,36.72,36.72,244,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,41.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,43.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,89.18,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,42.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,41.28,448,,facility
IMMUNOASSAY QUANT NOS NONAB,83520,CPT,301,RC,,,,outpatient,,,448,44.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,36,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,66.08,66.08,66.08,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,41.18,24.82,318.38,1 through 10,percent of total billed charges,,,33.6,,37.63,37.63,96.43,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,33.6,23.18,176.4,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,36.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,87,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.22,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.27,448,,facility
FLOWCYTOMETRY/ TC 1 MARKER,88184,CPT,311,RC,,,,outpatient,,,854,85.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,315.62,315.62,343.05,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,546.56,546.56,731.52,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,343.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,343.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,353.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,286.94,286.94,384.05,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,343.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,716.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,363.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,179.34,179.34,179.34,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,63.07,63.07,165.15,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,343.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,363.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,377,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,349.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,343.05,716.97,,facility
UNLISTED MOLECULAR PATHOLOGY,81479,CPT,310,RC,,,,outpatient,,,3227,322.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,561.56,561.56,561.56,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,32.5,32.5,3071.5,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
SCREENING TEST FOR ANTIBODY TO NONINFECTIOUS AGENT,86255,CPT,0302,RC,,,,outpatient,,,86,8.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.72,10.72,10.72,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,45.41,28.9,1068.67,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,28.9,28.9,28.9,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.72,10.72,10.72,19,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.04,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.05,448,,facility
PROS SOCK MULTI PLY UPPER LM,L8435,HCPCS,274,RC,,,,outpatient,,,47,4.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,66,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,61,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,29.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,61.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,31.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,29.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,31.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,30.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,29.52,61.7,,facility
FLUORESCENT ANTIBODY TITER,86256,CPT,302,RC,,,,outpatient,,,311,31.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.72,10.72,10.72,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.04,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.05,448,,facility
MUMPS ANTIBODY,86735,CPT,302,RC,,,,outpatient,,,219,21.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.61,11.61,11.61,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,22.18,22.18,85.01,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,68.61,68.61,68.61,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,44,44,44,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.61,11.61,11.61,15,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.19,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.05,448,,facility
LATERAL TROCHANTERIC PAD,L1290,HCPCS,274,RC,,,,outpatient,,,136,13.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,66,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,61,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,90.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,90.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,93.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,90.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,188.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,95.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,90.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,95.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,92.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,90.32,188.77,,facility
PERQ VERTEBRAL AUGMENTATION,22515,CPT,320,RC,,,,outpatient,,,15461,1546.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,179.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,179.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,185.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,179.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,375.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,190.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,179.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,190.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,183.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,179.7,1173,,facility
CLOTTING FACTOR V (ACG OR PROACCELERIN) MEASUREMENT,85220,CPT,0305,RC,,,,outpatient,,,171.5,17.15,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,36.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.7,15.7,15.7,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.13,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.65,448,,facility
TISSUE EXAM BY PATHOLOGIST,88307,CPT,310,RC,,,,outpatient,,,116,11.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,316.43,315.62,343.05,13,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,588.16,588.16,588.16,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,343.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,343.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,353.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,412.63,308.78,617.57,16,percent of total billed charges,,,33.6,,308.78,308.78,926.35,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,308.78,308.78,617.57,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,343.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,716.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,363.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,459.5,459.5,459.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,192.99,192.99,385.98,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,168.02,168.02,174.02,77,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,343.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,363.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,377,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,349.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,343.05,716.97,,facility
APPLICATION OF CHEMICAL TO STOP TISSUE REGROWTH IN WOUND,17250,CPT,0450,RC,,,,outpatient,,,395,39.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,197.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,401.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,203.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,203.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,195.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,192.01,1173,,facility
STREP A AG IA,87430,CPT,306,RC,,,,outpatient,,,22,2.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,14.95,14.95,14.95,49,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,62.72,62.72,62.72,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,12.98,12.98,12.98,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,51.74,32.93,55.96,13,percent of total billed charges,,,33.6,,32.93,32.93,51.74,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,32.93,25.43,32.93,15,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,35.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,20.58,20.58,20.58,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,14.95,14.95,14.95,106,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.42,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,16.81,448,,facility
INSULIN MEASUREMENT; TOTAL,83525,CPT,0301,RC,,,,outpatient,,,62,6.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.17,10.17,10.17,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,20.83,20.83,20.83,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,21.02,20.83,63.84,11,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,23.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.17,10.17,10.17,12,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.69,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,11.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.43,448,,facility
REMOVAL OF POLYPS OR GROWTHS OF LOWER LARGE BOWEL USING A FLEXIBLE ENDOSCOPE WITH MECHANICAL SNARE,45338,CPT,0750,RC,,,,outpatient,,,4873,487.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,1034.53,1034.53,1034.53,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1179.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,2393.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1213.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1213.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3821,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1168.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3821,,facility
SHEATH ABOVE KNEE,L8410,HCPCS,274,RC,,,,outpatient,,,44,4.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,66,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,61,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,28.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,58.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,29.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,28.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,29.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,28.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,28.16,58.85,,facility
NUCLEAR ANTIGEN ANTIBODY,86235,CPT,302,RC,,,,outpatient,,,66,6.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13,12.5,15.95,11,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,54.91,4.37,90.29,43,percent of total billed charges,,,33.6,,4.37,4.37,53.09,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,22.18,4.24,83.33,13,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,37.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.95,13,15.95,54,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.75,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.93,448,,facility
NK CELLS TOTAL COUNT,86357,CPT,302,RC,,,,outpatient,,,272,27.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,33.56,33.56,33.56,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,60.77,60.77,60.77,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,37.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,37.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,27.98,27.98,27.98,1 through 10,percent of total billed charges,,,33.6,,33.56,33.56,33.56,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,537.59,537.59,537.59,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,78.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,39.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,33.56,33.56,33.56,25,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,39.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,81.52,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,38.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,37.73,448,,facility
BIOPSY OF LARGE BOWEL USING A FLEXIBLE ENDOSCOPE,45380,CPT,0750,RC,,,,outpatient,,,4873,487.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,1034.53,968.51,1056.38,45,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1179.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,2362.63,1768.03,2362.64,13,percent of total billed charges,,,33.6,,1768.03,1768.03,1768.03,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,1768.03,1651.95,1768.03,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,2393.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1213.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,2631,2631,2631,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,1049.99,1049.99,1077.58,53,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1213.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3821,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1168.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3821,,facility
SPECIAL GRAM OR GIEMSA STAIN FOR MICROORGANISM,87205,CPT,0306,RC,,,,outpatient,,,282,28.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.8,3.8,3.8,30,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,180.48,3.16,180.48,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,166.38,166.38,166.38,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,94.75,94.75,148.9,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,94.75,94.75,95.6,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,8.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.8,3.8,3.8,139,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.22,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,4.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,4.27,448,,facility
AMINO ACIDS SINGLE QUANT,82131,CPT,301,RC,,,,outpatient,,,226,22.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,23.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,48.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,24.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,24.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,40.22,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,23.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,22.98,448,,facility
CYTOGENETICS DNA PROBE,88271,CPT,311,RC,,,,outpatient,,,271,27.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.05,19.05,19.05,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,1274.11,1274.11,1274.11,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,477.79,477.79,477.79,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,21.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,44.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.05,19.05,19.05,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,21.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,46.27,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,21.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,21.42,448,,facility
SPECIAL STAINS GROUP 2,88313,CPT,310,RC,,,,outpatient,,,294,29.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,117.45,117.45,127.33,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,131.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,1158.42,1158.42,1448.02,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,216.72,216.72,650.16,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,266.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,134.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,322.5,322.5,322.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,56.91,56.91,59.4,38,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,134.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,55.65,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,129.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,55.65,448,,facility
TOTAL CELL COUNT FOR B CELLS (WHITE BLOOD CELLS),86355,CPT,0302,RC,,,,outpatient,,,133,13.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,33.56,33.56,33.56,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,60.77,60.77,60.77,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,37.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,37.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,27.98,27.98,27.98,1 through 10,percent of total billed charges,,,33.6,,33.56,33.56,33.56,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,63.63,63.63,63.63,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,78.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,39.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,33.56,33.56,33.56,25,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,39.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,81.52,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,38.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,37.73,448,,facility
COL CHROMOTOGRAPHY QUAL/QUAN,82542,CPT,301,RC,,,,outpatient,,,1557,155.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,21.43,21.43,21.43,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,435.07,435.07,435.07,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,24.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,50.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,25.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,21.43,21.43,21.43,15,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,24.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,25.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.16,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,24.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,24.09,448,,facility
SIMPLE DESTRUCTION OF GROWTH OF PENIS USING FREEZING,54056,CPT,0761,RC,,,,outpatient,,,3201,320.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,197.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,401.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,203.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,203.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,195.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,192.01,448,,facility
TRANSLOCATION ANALYSIS (BCR/ABL1) MAJOR BREAKPOINT,81206,CPT,0310,RC,,,,outpatient,,,1709,170.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,145.84,145.84,145.84,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,163.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,163.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,168.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,163.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,342.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,173.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,358.89,358.89,358.89,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,163.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,173.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,354.24,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,167.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,163.96,448,,facility
BIOPSY OF PROSTATE GLAND,55700,CPT,0761,RC,,,,outpatient,,,5513,551.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 103.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment.",,,,0,other,"Payer contract is 103.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment. + No services performed during 15-month lookback period",,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment. + No services performed during 15-month lookback period",,,"Payer contract is 209.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment.",,,,0,other,"Payer contract is 209.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment. + No services performed during 15-month lookback period",,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment. + No services performed during 15-month lookback period",,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,"Payer contract is 102.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment.",1987.55,1987.55,1987.55,1 through 10,other,"Payer contract is 102.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment.",448,1311,,facility
INFECTIOUS AGENT DRUG SUSCEPTIBILITY ANALYSIS,87900,CPT,0306,RC,,,,outpatient,,,230,23,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,130.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,130.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,134.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,130.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,272.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,138.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,130.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,138.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,281.61,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,132.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,130.35,448,,facility
ASSAY OF SERUM SODIUM,84295,CPT,301,RC,,,,outpatient,,,14,1.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.28,4.28,4.28,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,9.62,9.62,9.62,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,36.54,21.5,36.54,1 through 10,percent of total billed charges,,,33.6,,21.5,21.5,21.5,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,21.5,16.47,43.01,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,10.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.28,4.28,4.28,39,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.4,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,4.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,4.81,448,,facility
BLOOD GASES ANY COMBINATION,82803,CPT,301,RC,,,,outpatient,,,929,92.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,23.19,23.19,23.19,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,182.16,115.92,197,26,percent of total billed charges,,,33.6,,115.92,107.14,115.92,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,115.92,89.84,228.59,16,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,26.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,54.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,27.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,172.5,172.5,172.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,23.19,23.19,23.19,245,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,26.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,27.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,45.62,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,26.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,26.07,448,,facility
ASSAY OF NICKEL,83885,CPT,301,RC,,,,outpatient,,,196,19.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,24.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,51.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,25.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,24.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,25.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,52.96,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,24.51,448,,facility
INITIAL NEW PATIENT PREVENTIVE MEDICINE EVALUATION (1-4 YEARS),99382,CPT,0770,RC,,,,outpatient,,,594,59.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,67.92,67.92,67.92,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
ANGIOTENSIN I ENZYME TEST,82164,CPT,301,RC,,,,outpatient,,,99,9.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.99,12.99,12.99,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,42.67,12.77,67.06,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,42.88,42.88,42.88,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,30.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.99,12.99,12.99,26,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,31.55,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.6,448,,facility
INJ ENFORT VEDO-EJFV 0.25MG,J9177,HCPCS,636,RC,,,,outpatient,,,109,10.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,36.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,37.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,36.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,76.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,38.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,36.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,38.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,78.8,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,37.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,36.66,448,,facility
TEST FOR DETECTING GENES ASSOCIATED WITH BLOOD CANCER,81246,CPT,0310,RC,,,,outpatient,,,1159,115.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,85.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,173.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,87.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,87.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,145.25,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,84.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,83,448,,facility
MEASUREMENT OF SUBSTANCE USING IMMUNOASSAY TECHNIQUE; BY RADIOIMMUNOASSAY,83519,CPT,0301,RC,,,,outpatient,,,1523,152.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,55.44,55.44,55.44,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.37,16.37,16.37,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.2,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.4,448,,facility
ENCEPHALTIS WEST EQNE ANTBDY,86654,CPT,302,RC,,,,outpatient,,,52,5.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.49,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.19,448,,facility
HEPARIN ASSAY,85520,CPT,305,RC,,,,outpatient,,,259,25.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.64,11.64,11.64,13,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,131.71,49.68,223.83,17,percent of total billed charges,,,33.6,,131.71,131.71,131.71,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,131.76,131.71,132.89,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,196,196,196,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,82.32,82.32,82.32,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.64,11.64,11.64,91,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.28,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.09,448,,facility
BLOOD TYPING FOR RED BLOOD CELL ANTIGENS,86905,CPT,0300,RC,,,,outpatient,,,665,66.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,343.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,343.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,353.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,343.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,716.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,363.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.41,3.41,3.41,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,343.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,363.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.28,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,349.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,8.28,716.97,,facility
ESTABLISHED PATIENT PERIODIC PREVENTIVE MEDICINE EXAMINATION (40-64 YEARS),99396,CPT,0770,RC,,,,outpatient,,,462,46.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,122.58,122.58,122.58,1 through 10,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
"STERILE WATER/SALINE, 10 ML",A4216,HCPCS,272,RC,,,,outpatient,,,3,0.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",448,448,,facility
VANCOMYCIN (ANTIBIOTIC) LEVEL,80202,CPT,0301,RC,,,,outpatient,,,572,57.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,28.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.04,12.04,12.04,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.26,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.54,448,,facility
PMS2 GENE FULL SEQ ANALYSIS,81317,CPT,310,RC,,,,outpatient,,,420,42,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,676.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,676.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,696.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,676.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1413.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,717.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,676.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,717.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1237.29,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,690.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1413.88,,facility
X-RAY OF COLLAR BONE,73000,CPT,0320,RC,,,,outpatient,,,891,89.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,85.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,174.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.95,19.95,20.53,20,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,84.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,83.29,448,,facility
MOPATH PROCEDURE LEVEL 2,81401,CPT,310,RC,,,,outpatient,,,448,44.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,121.86,121.86,121.86,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,137,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,137,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,141.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,137,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,286.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,145.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,137,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,145.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,239.75,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,139.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,137,448,,facility
SIMPLE REPAIR OF SURFACE WOUND OF SCALP; NECK; UNDERARMS; TRUNK; ARMS; OR LEGS; 2.5 CM OR LESS,12001,CPT,0450,RC,,,,outpatient,,,1584,158.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,174.34,174.34,174.34,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,197.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,904.46,904.46,904.47,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,532.22,532.22,536.98,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,401.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,203.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,176.95,176.95,176.95,45,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,203.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,195.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,192.01,1173,,facility
COL CHROMOTOGRAPHY QUAL/QUAN,82542,CPT,301,RC,,,,outpatient,,,600,60,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,21.43,21.43,21.43,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,435.07,435.07,435.07,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,24.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,50.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,25.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,21.43,21.43,21.43,15,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,24.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,25.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.16,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,24.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,24.09,448,,facility
EVALUATION OF BRAIN RESPONSE TO SOUND FOR DETERMINATION OF HEARING THRESHOLD WITH INTERPRETATION AND REPORT,92652,CPT,0471,RC,,,,outpatient,,,14482,1448.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,273.22,273.22,273.22,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,206.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,206.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,212.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,206.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,431.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,219.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,92.49,92.49,98.21,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,206.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,219.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,425,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,210.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,206.65,448,,facility
MULTI-AXIAL ROTATION UNIT,L5986,HCPCS,274,RC,,,,outpatient,,,1216,121.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,66,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,61,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,818.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,818.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,843.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,818.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1711.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,868.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,818.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,868.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,835.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,818.99,1711.69,,facility
MRI SCAN OF BOTH BREASTS WITHOUT CONTRAST,77047,CPT,0610,RC,,,,outpatient,,,6472,647.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1025,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1350,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,235.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,477.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,242.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,242.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2407,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,232.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,228.36,2407,,facility
COAGULATION FUNCTION MEASUREMENT; D-DIMER; QUANTITATIVE,85379,CPT,0305,RC,,,,outpatient,,,427,42.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9.05,9.05,9.05,15,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,20.36,20.36,20.36,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,243.82,143.47,243.82,35,percent of total billed charges,,,33.6,,172.63,67.58,243.82,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,143.47,43.01,144.75,15,percent of total billed charges,,,34.6,,157.99,157.99,157.99,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,21.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,213.5,213.5,213.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,89.67,89.67,89.67,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9.05,9.05,9.05,185,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.98,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,10.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,10.18,448,,facility
BIOPSY OF LOWER LARGE BOWEL USING A FLEXIBLE ENDOSCOPE,45331,CPT,0750,RC,,,,outpatient,,,3740,374,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,890.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,890.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,916.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,890.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1860.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,943.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,811.89,405.95,811.89,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,890.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,943.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2712,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,907.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,2712,,facility
IMMUNOASSAY QUANT NOS NONAB,83520,CPT,301,RC,,,,outpatient,,,315,31.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,36,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,66.08,66.08,66.08,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,41.18,24.82,318.38,1 through 10,percent of total billed charges,,,33.6,,37.63,37.63,96.43,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,33.6,23.18,176.4,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,36.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,87,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.22,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.27,448,,facility
KO DOUBLE UPRIGHT PRE CST,L1845,HCPCS,274,RC,,,,outpatient,,,1599,159.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,66,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,61,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1076.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1076.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1108.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1076.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,2249.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1140.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1076.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1140.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,1097.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,1076.32,2249.51,,facility
CACNA1A GENE FULL GENE SEQ,81185,CPT,310,RC,,,,outpatient,,,673,67.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,846.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,846.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,871.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,846.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1768.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,897.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,846.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,897.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1480.97,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,863.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1768.7,,facility
ULTRASOUND OF HEART FOR CONGENITAL DEFECT; FOLLOW-UP,93304,CPT,0480,RC,,,,outpatient,,,2756,275.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,481.08,481.08,492.05,72,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,2028.16,2028.16,2028.16,12,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,1869.71,1869.71,1869.71,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,522.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,522.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,538.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,1673.23,1673.23,1673.23,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,1064.78,934.28,1064.78,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,522.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1092.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,554.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,488.27,488.27,492.05,65,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,522.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,554.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1463,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,533.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1463,,facility
SC STD AGAR DILUTION PER AGT,87181,CPT,306,RC,,,,outpatient,,,300,30,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,9.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.26,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,4.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,4.75,448,,facility
KNEE-SHIN EXO FRCT SWG & STA,L5718,HCPCS,274,RC,,,,outpatient,,,1686,168.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,66,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,61,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1145.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1145.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1180.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1145.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,2395.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1214.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1145.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1214.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,1168.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,1145.99,2395.12,,facility
ASSESSMENT OF ANTIBODY TO HUMAN LEUKOCYTE ANTIGENS (HLA) WITH HIGH DEFINITION QUALITATIVE PANEL FOR IDENTIFICATION OF ANTIBODY SPECIFICITIES; HLA CLASS I,86832,CPT,0302,RC,,,,outpatient,,,1368,136.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,287.97,287.97,287.97,24,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,323.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,323.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,333.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,599.81,599.81,599.81,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,521.21,521.21,521.21,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,323.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,676.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,343.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,287.97,287.97,577.76,18,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,323.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,343.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,566.56,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,330.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,323.75,676.64,,facility
ASSAY OF ALDOSTERONE,82088,CPT,301,RC,,,,outpatient,,,286,28.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,36.25,36.25,36.25,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,32.45,32.45,63.72,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,40.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,40.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,41.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,29.04,18.48,29.04,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,18.48,17.81,46.37,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,40.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,85.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,43.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,36.25,36.25,36.25,24,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,40.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,43.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,88.04,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,41.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,40.75,448,,facility
VIRUS ANTIBODY NOS,86790,CPT,302,RC,,,,outpatient,,,213,21.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.46,11.46,11.46,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,107.86,20.06,169.49,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,116.52,40.29,122.3,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,26.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.46,11.46,11.46,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.88,448,,facility
N.GONORRHOEAE DNA AMP PROB,87591,CPT,306,RC,,,,outpatient,,,43,4.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,442,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,50.15,20.65,65.49,11,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,228.48,228.48,228.48,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,37.3,18.48,58.61,60,percent of total billed charges,,,33.6,,37.3,11.76,63.38,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,28.82,11.76,37.3,69,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,42.5,17.5,55.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,23.31,23.31,23.31,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,31.21,31.21,31.21,1 through 10,percent of total billed charges,,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,796,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
STREP A ASSAY W/OPTIC,87880,CPT,306,RC,,,,outpatient,,,22,2.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,34.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.93,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,16.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,16.53,448,,facility
3D RADIATION THERAPY PLANNING,77295,CPT,0333,RC,,,,outpatient,,,12295,1229.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,7868.8,7868.8,7868.8,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1324.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1324.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1364.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,4131.12,4131.12,4131.12,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,4131.12,4131.12,4168.01,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1324.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,2768.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1404.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1324.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1404.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,48815,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1351.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,48815,,facility
DIAGNOSTIC EXAM OF LUNG AIRWAY USING AN ENDOSCOPE,31622,CPT,0750,RC,,,,outpatient,,,7194,719.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,1703.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1703.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1754.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1703.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3560.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1805.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1703.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1805.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3821,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1737.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3821,,facility
ULTRASOUND OF HEART WITH COLOR-DEPICTED BLOOD FLOW; RATE; DIRECTION AND VALVE FUNCTION,93306,CPT,0483,RC,,,,outpatient,,,6586,658.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,481.08,481.08,522.95,571,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,4215.04,4215.04,4215.04,57,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,3885.74,3885.74,3885.74,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,522.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,522.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,538.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,3477.41,2212.9,3477.41,52,percent of total billed charges,,,33.6,,2232.65,2212.9,6058.8,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,2212.9,2212.9,2232.65,40,percent of total billed charges,,,34.6,,2436.82,2436.82,2436.82,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,522.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1092.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,554.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,3293,3293,3293,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,102.2,102.2,107.4,512,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,522.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,554.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,566,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,533.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1092.97,,facility
DIAGNOSTIC EXAM OF NASAL PASSAGES USING AN ENDOSCOPE,31231,CPT,0761,RC,,,,outpatient,,,868,86.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,191.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,191.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,196.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,191.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,399.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,202.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,172.88,172.88,172.88,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,191.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,202.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,194.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,191.04,1311,,facility
TRANSFER OF SKIN FLAP TO EYELIDS; NOSE; EARS; OR LIPS,15630,CPT,0761,RC,,,,outpatient,,,3201,320.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1027,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1519,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1974.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1974.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2033.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1974.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,4127.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2093.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1974.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2093.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,2014.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,4127.08,,facility
REMOVAL OF CEREBROSPINAL FLUID WITH LOWER BACK SPINAL TAP FOR DIAGNOSTIC TEST,62270,CPT,0761,RC,,,,outpatient,,,2296,229.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,607.62,586.32,616.7,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,675.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,675.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,695.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,925.01,925.01,925.01,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,675.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1411.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,716.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,616.7,616.7,925.05,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,675.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,716.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,689.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1411.94,,facility
T CELL ABSOLUTE COUNT/RATIO,86360,CPT,302,RC,,,,outpatient,,,756,75.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,41.79,41.79,41.79,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,64.31,64.31,64.31,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,46.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,46.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,48.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,31.15,31.15,31.15,1 through 10,percent of total billed charges,,,33.6,,41.79,41.79,41.79,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,288.04,288.04,288.04,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,46.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,98.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,49.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,41.79,41.79,41.79,27,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,46.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,49.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,101.52,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,47.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,46.98,448,,facility
DESTRUCTION OF SKIN GROWTH; 15 OR MORE GROWTHS,17111,CPT,0761,RC,,,,outpatient,,,593,59.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,174.34,174.34,174.34,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,197.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,401.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,203.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,176.95,176.95,180.67,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,203.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,195.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,192.01,1173,,facility
INSERTION OF TUBE INTO GALLBLADDER USING IMAGING GUIDANCE WITH REVIEW BY RADIOLOGIST,47490,CPT,0361,RC,,,,outpatient,,,5667,566.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3096.41,3096.41,3096.41,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,1015.76,1015.76,1015.76,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,3426.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3426.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3529.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3426.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,7161.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3632.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3426.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3632.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10137,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,3495.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,10137,,facility
EVALUATION OF SINGLE OR DUAL CHAMBER PACING CARDIOVERTER-DEFIBRILLATOR AND GENERATOR AT TIME OF IMPLANTATION OR REPLACEMENT,93641,CPT,0480,RC,,,,outpatient,,,5326,532.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2004,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,2759,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,284.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,284.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,292.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,284.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,593.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,301.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,284.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,301.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1463,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,289.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,284.2,2759,,facility
REPLACEMENT OF STOMACH OR LARGE BOWEL TUBE USING FLUOROSCOPIC GUIDANCE WITH CONTRAST,49450,CPT,0361,RC,,,,outpatient,,,4235,423.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,822.62,822.62,822.62,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,868.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,868.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,894.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,868.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1814.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,920.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,868.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,920.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3821,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,885.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3821,,facility
BLOOD PLATELET AGGREGATION,85576,CPT,305,RC,,,,outpatient,,,677,67.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,22.16,22.16,22.16,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,70.56,70.56,70.56,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,24.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,52.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,26.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,22.16,22.16,22.16,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,24.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,26.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,46.41,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,25.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,24.91,448,,facility
MASS SPECTROMETRY QUAL/QUAN,83789,CPT,301,RC,,,,outpatient,,,360,36,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,24.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,50.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,25.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,24.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,25.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.19,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,24.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,24.11,448,,facility
MOPATH PROCEDURE LEVEL 5,81404,CPT,310,RC,,,,outpatient,,,276,27.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,274.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,274.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,283.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,274.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,574.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,291.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,274.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,291.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,480.95,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,280.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,274.83,574.39,,facility
MLH1 GENE,81288,CPT,310,RC,,,,outpatient,,,1203,120.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,192.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,192.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,198.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,192.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,401.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,203.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,192.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,203.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,336.56,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,196.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,192.32,448,,facility
ULTRASOUND SCAN OF CHEST,76604,CPT,0402,RC,,,,outpatient,,,643,64.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,535.04,535.04,535.04,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,441.41,441.41,441.41,1 through 10,percent of total billed charges,,,33.6,,280.9,280.9,280.9,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,280.9,280.9,280.9,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,25.25,25.25,25.25,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,465,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,465,,facility
SOCKET INSERT W/O LOCK MECH,L5679,HCPCS,274,RC,,,,outpatient,,,1109,110.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,66,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,61,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,747.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,747.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,769.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,747.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1562,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,792.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,747.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,792.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,762.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,747.37,1562,,facility
ASSAY OF TOTAL ESTRADIOL,82670,CPT,301,RC,,,,outpatient,,,63,6.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,24.85,24.85,24.85,51,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,47.79,39.12,263.73,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,42.77,42.77,42.77,15,percent of total billed charges,,,33.6,,42.77,27.46,236.02,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,27.46,27.22,150.19,27,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,27.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,58.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,29.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,40.5,40.5,40.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,17.01,17.01,17.01,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,24.85,24.85,24.85,85,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,27.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,29.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,60.36,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,28.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,27.94,448,,facility
ABDUCTION BAR JOINTED ADJUST,L2300,HCPCS,274,RC,,,,outpatient,,,614,61.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,66,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,61,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,412.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,412.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,424.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,412.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,862.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,437.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,412.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,437.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,420.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,412.52,862.17,,facility
VIT D 1 25-DIHYDROXY,82652,CPT,301,RC,,,,outpatient,,,79,7.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,34.25,34.25,34.25,16,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,30.68,30.68,30.68,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,39.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,41.71,17.47,46.99,1 through 10,percent of total billed charges,,,33.6,,17.47,17.47,29.9,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,26.78,26.54,26.78,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,38.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,80.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,40.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,39.5,39.5,39.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,34.25,34.25,34.25,35,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,38.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,40.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.18,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,39.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,38.5,448,,facility
BRAF GENE,81210,CPT,310,RC,,,,outpatient,,,590,59,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,156.02,156.02,156.02,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,175.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,175.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,180.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,175.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,366.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,185.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,156.02,156.02,156.02,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,175.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,185.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,306.95,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,178.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,175.4,448,,facility
ENZYME CELL ACTIVITY,82657,CPT,301,RC,,,,outpatient,,,1400,140,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.72,19.72,19.72,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,2094.14,2094.14,2094.14,1 through 10,percent of total billed charges,,,33.6,,762.96,762.96,762.96,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,46.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,23.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.72,19.72,19.72,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,23.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,39.01,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,22.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,22.17,448,,facility
HEPATITIS A ANTIBODY,86708,CPT,302,RC,,,,outpatient,,,600,60,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.02,11.02,11.02,30,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,76.16,76.16,76.16,24,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,70.21,70.21,70.21,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,62.83,39.98,62.83,12,percent of total billed charges,,,33.6,,39.98,39.98,62.83,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,39.98,39.98,201.6,23,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,59.5,59.5,59.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.02,11.02,11.02,102,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.76,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.39,448,,facility
PUNCH BIOPSY; FIRST SKIN GROWTH,11104,CPT,0450,RC,,,,outpatient,,,586,58.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,400.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,813.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,412.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,412.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,396.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,389.05,813.11,,facility
COL CHROMOTOGRAPHY QUAL/QUAN,82542,CPT,301,RC,,,,outpatient,,,927,92.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,21.43,21.43,21.43,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,435.07,435.07,435.07,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,24.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,50.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,25.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,21.43,21.43,21.43,15,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,24.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,25.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.16,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,24.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,24.09,448,,facility
ASPIRATION AND/OR INJECTION OF FLUID FROM SMALL JOINT USING ULTRASOUND GUIDANCE,20604,CPT,0361,RC,,,,outpatient,,,1057,105.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,293.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,293.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,302.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,293.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,613.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,311.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,293.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,311.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2440,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,299.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,293.77,2440,,facility
KO W/0 JOINT RIGID MOLDED TO,L1834,HCPCS,274,RC,,,,outpatient,,,1323,132.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,66,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,61,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,892.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,892.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,918.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,892.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1864.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,945.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,892.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,945.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,909.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,892.02,1864.32,,facility
INJ IVIG PRIVIGEN 500 MG,J1459,HCPCS,636,RC,,,,outpatient,,,119,11.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,18591.78,18591.78,18591.78,70,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,51.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,51.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,52.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,806.82,806.82,1613.64,81,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,51.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,107.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,54.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,51.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,54.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,105.95,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,52.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,51.22,448,,facility
X-RAY OF MIDDLE SPINE; 3 VIEWS,72072,CPT,0320,RC,,,,outpatient,,,1209,120.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,773.76,773.76,773.76,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,406.22,406.22,406.22,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,23.18,23.18,24.14,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,448,,facility
PMS2 GENE DUP/DELET VARIANTS,81319,CPT,310,RC,,,,outpatient,,,223,22.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,203.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,203.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,209.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,203.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,425.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,215.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,203.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,215.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,356.13,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,207.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,203.5,448,,facility
TEST FOR DETECTING NUCLEIC ACID OF ORGANISM CAUSING INFECTION OF CENTRAL NERVOUS SYSTEM,87483,CPT,0306,RC,,,,outpatient,,,1672,167.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,416.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,416.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,429.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,416.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,871.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,441.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,416.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,441.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,900.46,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,425.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,416.78,900.46,,facility
TEST FOR DETECTING GENES ASSOCIATED WITH COLON CANCER; PROMOTER METHYLATION ANALYSIS,81288,CPT,0310,RC,,,,outpatient,,,1263,126.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,192.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,192.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,198.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,192.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,401.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,203.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,192.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,203.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,336.56,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,196.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,192.32,448,,facility
ASSAY OF COPPER,82525,CPT,301,RC,,,,outpatient,,,347,34.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.04,11.04,11.04,18,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,35.64,22.85,35.9,1 through 10,percent of total billed charges,,,33.6,,80.64,80.64,80.64,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,22.85,19.49,22.85,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,50.4,50.4,50.4,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.04,11.04,11.04,37,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.81,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.41,448,,facility
X-RAY OF CHEST; 2 VIEWS,71046,CPT,0320,RC,,,,outpatient,,,683,68.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,77.25,76.83,83.29,724,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,437.12,437.12,437.12,35,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,402.97,40.3,402.97,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,85.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,360.62,229.49,389.99,46,percent of total billed charges,,,33.6,,229.49,229.49,360.62,13,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,229.49,229.49,231.54,37,percent of total billed charges,,,34.6,,260.22,260.22,260.22,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,174.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,341.5,341.5,341.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,143.43,143.43,143.43,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,18.87,18.87,19.41,574,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,84.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,83.29,448,,facility
IMMUNOASSAY INFECTIOUS AGENT,86317,CPT,302,RC,,,,outpatient,,,282,28.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.33,13.33,13.33,86,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,59,59,59,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,52.8,26.54,52.8,41,percent of total billed charges,,,33.6,,52.8,33.6,52.8,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,33.6,33.6,33.73,52,percent of total billed charges,,,34.6,,218.53,218.53,218.53,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,31.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,50,50,50,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.33,13.33,13.33,209,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.38,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,15.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.99,448,,facility
COL CHROMOTOGRAPHY QUAL/QUAN,82542,CPT,301,RC,,,,outpatient,,,385,38.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,21.43,21.43,21.43,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,435.07,435.07,435.07,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,24.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,50.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,25.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,21.43,21.43,21.43,15,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,24.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,25.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.16,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,24.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,24.09,448,,facility
GENOME SEQUENCE ANALYSIS,81425,CPT,310,RC,,,,outpatient,,,7848,784.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5031.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5031.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5182.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5031.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,10515.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5333.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5031.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5333.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8804.6,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5131.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,10515.21,,facility
SIMPLE INSERTION OF TEMPORARY BLADDER TUBE,51702,CPT,0450,RC,,,,outpatient,,,436,43.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,131.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,248.96,248.96,248.96,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,266.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,134.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,134.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,129.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,127.33,1173,,facility
BODY FLUID PH LEVEL,83986,CPT,0301,RC,,,,outpatient,,,168,16.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.18,3.18,3.18,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,75.43,75.43,75.43,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,7.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.18,3.18,3.18,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.74,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,3.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,3.58,448,,facility
UNLISTED MOLECULAR PATHOLOGY,81479,CPT,310,RC,,,,outpatient,,,2226,222.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,561.56,561.56,561.56,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,32.5,32.5,3071.5,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
INCISION AND DRAINAGE OF ABSCESS OF EXTERNAL FEMALE GENITALS,56405,CPT,0450,RC,,,,outpatient,,,867,86.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,291.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,291.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,300.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,291.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,609.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,309.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,270.89,270.89,270.89,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,291.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,309.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,297.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,291.64,1311,,facility
CLOTTING FACTOR VII (PROCONVERTIN; STABLE FACTOR),85230,CPT,0305,RC,,,,outpatient,,,102.6,10.26,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.92,15.92,15.92,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,37.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.92,15.92,15.92,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.68,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.9,448,,facility
GROUP PSYCHOTHERAPY,90853,CPT,0915,RC,,,,outpatient,,,1395,139.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,97.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,97.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,97.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,203.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,97.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,99.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,97.23,448,,professional
ASSAY NEPHELOMETRY NOT SPEC,83883,CPT,301,RC,,,,outpatient,,,176,17.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.1,12.1,12.1,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,173.18,51.22,173.18,1 through 10,percent of total billed charges,,,33.6,,31.58,31.58,31.58,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,31.58,31.53,110.21,11,percent of total billed charges,,,34.6,,119.06,117.35,124.97,24,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,28.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.1,12.1,12.1,29,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.38,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.6,448,,facility
ASSAY 17- KETOSTEROIDS,83586,CPT,301,RC,,,,outpatient,,,70,7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,26.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.65,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.8,448,,facility
IMMUNOASSAY QUANT NOS NONAB,83520,CPT,301,RC,,,,outpatient,,,1077,107.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,36,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,66.08,66.08,66.08,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,41.18,24.82,318.38,1 through 10,percent of total billed charges,,,33.6,,37.63,37.63,96.43,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,33.6,23.18,176.4,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,36.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,87,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.22,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.27,448,,facility
ACYLCARNITINES QUANT,82017,CPT,301,RC,,,,outpatient,,,151,15.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.01,15.01,15.01,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,279.84,279.84,279.84,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,35.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.01,15.01,15.01,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.45,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,16.87,448,,facility
SCREENING TEST FOR PRESENCE OF ANTIBODY,86403,CPT,0302,RC,,,,outpatient,,,291.75,29.18,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,154.18,154.18,154.18,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,24.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.26,10.26,10.26,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.02,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,11.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.54,448,,facility
QUANTITATIVE ASSAY DRUG,80299,CPT,301,RC,,,,outpatient,,,717,71.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,13,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,174.64,174.64,174.64,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,171.6,171.6,171.6,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,374.52,374.52,374.52,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.62,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.64,448,,facility
HIV-2 PROBE&REVRSE TRNSCRIPJ,87538,CPT,306,RC,,,,outpatient,,,142,14.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,122.13,122.13,122.13,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
TEST TO EXAMINE HOW WELL THE LUNGS EXCHANGE GASES,94729,CPT,0460,RC,,,,outpatient,,,1168,116.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,747.52,747.52,747.52,21,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,689.12,689.12,689.12,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,616.7,392.45,616.7,12,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,392.45,392.45,395.95,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,18.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,9.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,245.28,245.28,245.28,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,38.29,38.29,39.96,77,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,9.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,611,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,9.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,8.99,611,,facility
DESIGN AND CONSTRUCTION OF SIMPLE RADIATION TREATMENT DEVICE,77332,CPT,0333,RC,,,,outpatient,,,1617,161.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,128.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,128.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,132.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,557.09,557.09,557.09,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,128.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,268.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,136.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,128.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,136.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,48815,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,131.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,128.64,48815,,facility
OTHER SOURCE ALBUMIN QUAN EA,82042,CPT,301,RC,,,,outpatient,,,33,3.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,107.76,107.76,107.76,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,7.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,16.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,6.92,6.92,6.92,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,7.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.62,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,7.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,7.78,448,,facility
QUANTITATIVE ASSAY DRUG,80299,CPT,301,RC,,,,outpatient,,,72,7.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,13,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,174.64,174.64,174.64,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,171.6,171.6,171.6,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,374.52,374.52,374.52,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.62,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.64,448,,facility
ENDO KNEE-SHIN POLYC MCH STA,L5816,HCPCS,274,RC,,,,outpatient,,,1746,174.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,66,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,61,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1186.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1186.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1222.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1186.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,2479.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1257.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1186.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1257.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,1210.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,1186.56,2479.91,,facility
RBC SED RATE AUTOMATED,85652,CPT,305,RC,,,,outpatient,,,20,2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,2.4,2.4,2.4,155,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,12.8,12.8,12.8,42,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,11.8,11.8,11.8,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,10.56,6.72,147.32,64,percent of total billed charges,,,33.6,,10.56,6.72,86.69,12,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,6.78,6.72,86.69,51,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,5.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,10,10,129,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,4.2,4.2,4.2,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,2.4,2.4,2.4,674,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,2.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,2.7,448,,facility
CMV ANTIBODY,86644,CPT,302,RC,,,,outpatient,,,547,54.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.8,12.8,12.8,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,30.08,30.08,85.12,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,70.22,44.69,76.56,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,49.24,48.72,49.24,1 through 10,percent of total billed charges,,,34.6,,48.28,17.91,50.67,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,30.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.8,12.8,12.8,11,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,31.1,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.39,448,,facility
LIPOPROTEIN (A) LEVEL,83695,CPT,0301,RC,,,,outpatient,,,228,22.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.74,12.74,12.74,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,21.65,13.78,33.26,13,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,21.17,21.17,21.19,14,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,29.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,31.5,31.5,31.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.74,12.74,12.74,13,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.97,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.32,448,,facility
VALPROIC ACID LEVEL; TOTAL,80164,CPT,0301,RC,,,,outpatient,,,140.25,14.03,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.04,12.04,12.04,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,47.04,47.04,47.04,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,28.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.04,12.04,12.04,12,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.26,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.54,448,,facility
IMMUNFIX E-PHORSIS/URINE/CSF,86335,CPT,302,RC,,,,outpatient,,,55,5.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,26.11,26.11,26.11,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,25.76,25.76,25.76,1 through 10,percent of total billed charges,,,34.6,,56.99,56.99,56.99,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,29.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,61.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,31.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,26.11,26.11,26.11,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,29.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,31.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,63.4,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,29.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,29.35,448,,facility
INSITU HYBRIDIZATION (FISH),88365,CPT,310,RC,,,,outpatient,,,504,50.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,163,163,163,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,167.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,169.34,169.34,266.11,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,340.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,172.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,252,252,252,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,107.35,107.35,339.75,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,172.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,226.07,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,166.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,163.06,448,,facility
PROTEIN MEASUREMENT; SERUM,84165,CPT,0301,RC,,,,outpatient,,,545,54.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9.55,9.55,9.55,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,287.76,46.46,287.76,1 through 10,percent of total billed charges,,,33.6,,29.57,29.57,29.57,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,29.92,29.57,184.76,1 through 10,percent of total billed charges,,,34.6,,197.83,197.83,207.64,11,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,22.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9.55,9.55,9.55,33,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,23.21,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,10.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,10.74,448,,facility
ADENOVIRUS AG IA,87301,CPT,306,RC,,,,outpatient,,,223,22.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.9,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.98,448,,facility
DRUG SCREENING OXYCODONE,80365,CPT,301,RC,,,,outpatient,,,151,15.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
RUSSELL VIPER VENOM DILUTED,85613,CPT,305,RC,,,,outpatient,,,72,7.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,8.52,8.52,8.52,20,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,82.37,20.06,82.37,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,52.42,52.42,52.42,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,9.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,20.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,8.52,8.52,8.52,34,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,9.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.7,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,9.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,9.58,448,,facility
ASSAY OF FECES PORPHYRINS,84126,CPT,301,RC,,,,outpatient,,,356,35.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,39.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,39.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,40.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,39.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,81.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,41.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,39.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,41.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,68.44,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,39.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,39.11,448,,facility
LEUPROLIDE ACETATE SUSPNSION,J9217,HCPCS,636,RC,,,,outpatient,,,3135,313.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,160.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,160.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,165.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,160.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,335.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,169.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,160.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,169.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,388.7,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,163.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,160.34,448,,facility
COMPARATIVE ANALYSIS USING SHORT TANDEM REPEAT (STR) MARKERS OF PATIENT AND SPECIMEN,81265,CPT,0310,RC,,,,outpatient,,,2926,292.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,207.31,207.31,207.31,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,233.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,233.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,240.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,233.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,487.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,247.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,233.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,247.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,464.61,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,237.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,233.07,487.12,,facility
CEFTRIAXONE SODIUM INJECTION,J0696,HCPCS,636,RC,,,,outpatient,,,2,0.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,11.34,11.34,12.6,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,52.8,,6.48,3.82,7.28,117,percent of total billed charges,,,33.6,,3.81,2.31,6.57,17,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,2.88,2.86,4.96,24,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,50,,6.38,6.38,12.63,16,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",448,448,,facility
MOPATH PROCEDURE LEVEL 7,81406,CPT,310,RC,,,,outpatient,,,557,55.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,282.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,282.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,291.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,282.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,591.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,299.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,282.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,299.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,495.04,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,288.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,282.88,591.22,,facility
TRACHEOSTOMY CARE KIT,A4629,HCPCS,272,RC,,,,outpatient,,,12,1.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",448,448,,facility
ASSAY CARBAMAZEPINE TOTAL,80156,CPT,301,RC,,,,outpatient,,,602,60.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,47.04,47.04,47.04,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,30.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.96,12.96,12.96,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,31.47,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.57,448,,facility
QUANTITATIVE ASSAY DRUG,80299,CPT,301,RC,,,,outpatient,,,226,22.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,13,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,174.64,174.64,174.64,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,171.6,171.6,171.6,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,374.52,374.52,374.52,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.62,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.64,448,,facility
CYTOGENETICS 100-300,88275,CPT,311,RC,,,,outpatient,,,864,86.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,45.53,45.53,45.53,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,51.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,51.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,52.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,1828.51,1828.51,1828.51,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,401.18,401.18,401.18,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,51.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,106.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,54.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,45.53,45.53,45.53,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,51.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,54.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,89.58,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,52.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,51.19,448,,facility
ENDO BK ULTRA-LIGHT MATERIAL,L5940,HCPCS,274,RC,,,,outpatient,,,1216,121.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,66,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,61,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,818.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,818.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,843.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,818.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1711.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,867.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,818.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,867.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,835.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,818.79,1711.27,,facility
ENZYME CELL ACTIVITY,82657,CPT,301,RC,,,,outpatient,,,405,40.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.72,19.72,19.72,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,2094.14,2094.14,2094.14,1 through 10,percent of total billed charges,,,33.6,,762.96,762.96,762.96,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,46.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,23.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.72,19.72,19.72,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,23.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,39.01,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,22.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,22.17,448,,facility
ASSAY OF TROPONIN QUANT,84484,CPT,301,RC,,,,outpatient,,,928,92.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.09,11.09,11.09,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,312,312,312,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,83.94,49.39,178.15,66,percent of total billed charges,,,33.6,,83.94,49.39,126.14,15,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,49.39,49.39,148.18,37,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,26.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,156,156,312,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,23.73,23.73,23.73,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.09,11.09,11.09,460,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.82,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.47,448,,facility
IMMUNOASSAY QUANT NOS NONAB,83520,CPT,301,RC,,,,outpatient,,,105.6,10.56,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,36,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,66.08,66.08,66.08,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,41.18,24.82,318.38,1 through 10,percent of total billed charges,,,33.6,,37.63,37.63,96.43,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,33.6,23.18,176.4,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,36.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,87,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.22,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.27,448,,facility
INTERMEDIATE REPAIR OF WOUND OF SCALP; UNDERARMS; TRUNK; ARMS; OR LEGS; 12.6-20.0 CM,12035,CPT,0450,RC,,,,outpatient,,,1108,110.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,400.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,813.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,412.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,355.79,355.79,355.79,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,412.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,396.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,389.05,1311,,facility
HEPARIN ASSAY,85520,CPT,305,RC,,,,outpatient,,,100,10,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.64,11.64,11.64,13,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,131.71,49.68,223.83,17,percent of total billed charges,,,33.6,,131.71,131.71,131.71,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,131.76,131.71,132.89,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,196,196,196,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,82.32,82.32,82.32,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.64,11.64,11.64,91,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.28,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.09,448,,facility
MOPATH PROCEDURE LEVEL 7,81406,CPT,310,RC,,,,outpatient,,,3600,360,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,282.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,282.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,291.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,282.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,591.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,299.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,282.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,299.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,495.04,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,288.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,282.88,591.22,,facility
ALPHA-1-ANTITRYPSIN TOTAL,82103,CPT,301,RC,,,,outpatient,,,212,21.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.95,11.95,11.95,14,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,15.79,11.42,30.1,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,19.15,11.42,48.05,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,28.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.95,11.95,11.95,58,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.03,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.44,448,,facility
ULTRASOUND STUDY OF ARM OR LEG VEINS WITH COMPRESSION AND MANEUVERS,93970,CPT,0921,RC,,,,outpatient,,,4385,438.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,235.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,477.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,242.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,242.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1227,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,232.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,228.36,1227,,facility
CHEMILUMINESCENT ASSAY,82397,CPT,301,RC,,,,outpatient,,,144,14.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.56,12.56,12.56,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,22.85,22.85,22.85,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,29.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.56,12.56,12.56,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.5,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.12,448,,facility
STOOL CULTR AEROBIC BACT EA,87046,CPT,306,RC,,,,outpatient,,,177,17.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,62.83,62.83,62.83,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,9.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,19.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,9.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.41,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,9.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,9.44,448,,facility
THROMBOPLASTIN TIME PARTIAL,85732,CPT,305,RC,,,,outpatient,,,53,5.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.75,5.75,5.75,18,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,24.29,15.46,83.95,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,15.46,15.46,15.46,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,13.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.75,5.75,5.75,33,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.97,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,6.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,6.47,448,,facility
HEPATITIS A AND HEPATITIS B VACCINE,90636,CPT,0636,RC,,,,outpatient,,,388,38.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,355.3,355.3,355.3,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,186.53,186.53,186.53,1 through 10,percent of total billed charges,,,34.6,,201.52,201.52,201.52,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",448,448,,facility
COOMBS TEST INDIRECT TITER,86886,CPT,302,RC,,,,outpatient,,,653,65.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,150.35,150.35,150.35,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,167.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,340.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,172.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.61,4.61,4.61,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,172.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.18,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,166.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.18,448,,facility
FLUORESCENT ANTIBODY TITER,86256,CPT,302,RC,,,,outpatient,,,296,29.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.72,10.72,10.72,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.04,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.05,448,,facility
HBA1/HBA2 GENE DUP/DEL VRNTS,81269,CPT,310,RC,,,,outpatient,,,1860,186,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,180.03,180.03,180.03,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,202.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,202.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,208.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,292.99,292.99,292.99,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,202.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,423.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,214.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,202.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,214.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,354.2,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,206.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,202.4,448,,facility
GASTRIN (GI TRACT HORMONE) LEVEL,82941,CPT,0301,RC,,,,outpatient,,,240,24,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,36.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.68,15.68,15.68,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.1,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.63,448,,facility
THYROID HORMONE; T3 MEASUREMENT; FREE,84481,CPT,0301,RC,,,,outpatient,,,469,46.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.07,15.07,15.07,40,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,93.81,93.81,276.71,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,83.95,53.42,157.58,12,percent of total billed charges,,,33.6,,53.42,53.42,157.58,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,53.42,53.42,157.58,33,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,35.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.07,15.07,15.07,127,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.61,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,16.94,448,,facility
DRAINAGE OF BLOOD OR FLUID ACCUMULATION,10140,CPT,0450,RC,,,,outpatient,,,8046,804.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1628.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,5076.76,5076.76,5076.76,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3303.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1675.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,1442.85,1442.85,1442.85,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1675.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1612.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3303.62,,facility
BILE ACIDS LEVEL; TOTAL,82239,CPT,0301,RC,,,,outpatient,,,62,6.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.23,15.23,15.23,11,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,21.02,21.02,87.36,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,35.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,31,31,31,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.23,15.23,15.23,20,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,37,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.12,448,,facility
"BRACHYTX, NON-STRANDED,I-125",C2639,HCPCS,278,RC,,,,outpatient,,,91,9.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,66,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,61,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,37.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,36.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,76.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,38.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,36.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,38.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,37.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,36.46,76.2,,facility
RSV DNA/RNA AMP PROBE,87634,CPT,306,RC,,,,outpatient,,,187,18.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,70.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,70.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,72.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,70.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,146.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,74.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,70.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,74.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,151.66,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,71.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,70.2,448,,facility
ENZYME CELL ACTIVITY,82657,CPT,301,RC,,,,outpatient,,,1445,144.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.72,19.72,19.72,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,2094.14,2094.14,2094.14,1 through 10,percent of total billed charges,,,33.6,,762.96,762.96,762.96,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,46.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,23.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.72,19.72,19.72,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,23.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,39.01,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,22.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,22.17,448,,facility
THROMBOPLASTIN TIME PARTIAL,85730,CPT,305,RC,,,,outpatient,,,107,10.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.35,5.35,5.35,44,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,17.28,17.28,226.56,25,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,208.86,15.93,208.86,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,186.91,11.69,202.13,44,percent of total billed charges,,,33.6,,118.94,9.07,237.89,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,118.94,9.07,120.01,25,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,12.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,177,13.5,177,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.35,5.35,5.35,310,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.99,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,6.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,6.01,448,,facility
"INJ. RIABNI, 10 MG",Q5123,HCPCS,636,RC,,,,outpatient,,,301,30.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,18.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,15259.93,15259.93,15259.93,96,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,79.08,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.53,448,,facility
MOPATH PROCEDURE LEVEL 2,81401,CPT,310,RC,,,,outpatient,,,2155,215.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,121.86,121.86,121.86,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,137,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,137,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,141.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,137,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,286.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,145.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,137,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,145.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,239.75,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,139.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,137,448,,facility
HEPA VACCINE ADULT IM,90632,CPT,636,RC,,,,outpatient,,,245,24.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,63.38,63.38,63.38,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",448,448,,facility
PLASTIC MOD LOW EXT PAD/LINE,L2275,HCPCS,274,RC,,,,outpatient,,,224,22.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,66,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,61,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,150.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,150.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,154.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,150.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,313.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,159.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,150.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,159.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,153.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,150.13,313.77,,facility
SIMPLE BLADDER IRRIGATION AND/OR INSTILLATION,51700,CPT,0761,RC,,,,outpatient,,,638,63.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,239.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,239.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,246.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,278.54,278.54,278.54,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,239.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,499.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,253.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,239.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,253.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,243.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,239.12,1173,,facility
SLEEP STUDY IN SLEEP LAB WITH CONTINUOUS AIRWAY PRESSURE (YOUNGER THAN 6 YEARS),95783,CPT,0920,RC,,,,outpatient,,,12430,1243,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,892.66,892.66,892.66,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,821.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,821.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,846.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,821.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1717.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,871.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,726.83,726.83,726.83,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,821.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,871.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,422,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,838.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,422,1717.69,,facility
HEART RHYTHM RECORDING CONTINOUS EXTERNAL EKG OVER MORE THAN 48 HOURS UP TO 7 DAYS,93242,CPT,0730,RC,,,,outpatient,,,122,12.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,34.44,34.44,34.44,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,74.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9.42,9.42,9.97,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,389,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,36.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.74,448,,facility
REPAIR OF WOUND OF FOREHEAD; CHEEKS; CHIN; MOUTH; NECK; UNDERARMS; GENITALS; HANDS; OR FEET BY TRANSFERRING SKIN; 10.1-30.0 SQ CM,14041,CPT,0761,RC,,,,outpatient,,,3143,314.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1027,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1519,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1974.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1974.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2033.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1974.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,4127.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2093.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1974.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2093.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,2014.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,4127.08,,facility
ELECTRON MICROSCOPY DX,88348,CPT,310,RC,,,,outpatient,,,3053,305.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,716.75,711.24,771.08,14,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,2202.88,1496.32,2202.88,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,771.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,771.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,794.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,771.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1611.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,817.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,337.34,337.34,341.35,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,771.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,817.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,946.68,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,786.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1611.56,,facility
HERPES SIMPLEX TYPE 1 TEST,86695,CPT,302,RC,,,,outpatient,,,175,17.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.73,11.73,11.73,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,20.59,20.59,42.71,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,13.1,13.1,13.1,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.73,11.73,11.73,15,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.49,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.19,448,,facility
MYCOPLASMA ANTIBODY,86738,CPT,302,RC,,,,outpatient,,,223,22.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.78,11.78,11.78,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.6,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.24,448,,facility
UNLISTED SPECIAL SVC PX/RPRT,99199,CPT,981,RC,,,,outpatient,,,33,3.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,professional
DETECTION TEST FOR GARDNERELLA VAGINALIS (BACTERIA); DIRECT PROBE TECHNIQUE,87510,CPT,0306,RC,,,,outpatient,,,303.75,30.38,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,20.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,41.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,21.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,20.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,21.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,43.33,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,20.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,20.05,448,,facility
BLOOD GASES ANY COMBINATION,82803,CPT,301,RC,,,,outpatient,,,79,7.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,23.19,23.19,23.19,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,182.16,115.92,197,26,percent of total billed charges,,,33.6,,115.92,107.14,115.92,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,115.92,89.84,228.59,16,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,26.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,54.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,27.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,172.5,172.5,172.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,23.19,23.19,23.19,245,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,26.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,27.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,45.62,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,26.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,26.07,448,,facility
ASSAY OF COPPER,82525,CPT,301,RC,,,,outpatient,,,58,5.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.04,11.04,11.04,18,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,35.64,22.85,35.9,1 through 10,percent of total billed charges,,,33.6,,80.64,80.64,80.64,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,22.85,19.49,22.85,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,50.4,50.4,50.4,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.04,11.04,11.04,37,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.81,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.41,448,,facility
G6PD (ENZYME) SCREENING TEST,82960,CPT,0301,RC,,,,outpatient,,,69,6.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,36.43,36.43,36.43,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,12.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.38,5.38,5.38,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.07,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,6.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,6.05,448,,facility
PRETREATMENT OF RED BLOOD CELLS FOR USE IN RED BLOOD CELLS ANTIBODY ANALYSIS AND MEASUREMENT; INCUBATION WITH CHEMICAL AGENTS OR DRUGS,86970,CPT,0302,RC,,,,outpatient,,,401,40.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,56.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,56.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,58.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,145.56,145.56,145.56,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,56.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,118,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,59.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,56.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,59.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,55.65,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,57.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,55.65,448,,facility
ASSAY ALKALINE PHOSPHATASE,84075,CPT,301,RC,,,,outpatient,,,21,2.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.61,4.61,4.61,50,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,15.34,10.36,15.34,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,81,81,81,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,46.25,13.73,46.25,76,percent of total billed charges,,,33.6,,27.22,8.74,46.25,18,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,27.22,8.74,27.46,55,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,10.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,40.5,13,40.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,5.46,5.46,5.46,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.61,4.61,4.61,627,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.18,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.18,448,,facility
STR MARKERS SPECIMEN ANAL,81265,CPT,310,RC,,,,outpatient,,,1170,117,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,207.31,207.31,207.31,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,233.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,233.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,240.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,233.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,487.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,247.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,233.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,247.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,464.61,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,237.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,233.07,487.12,,facility
DETECT AGENT NOS DNA AMP,87798,CPT,306,RC,,,,outpatient,,,763,76.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,110.88,110.88,174.24,1 through 10,percent of total billed charges,,,33.6,,244.27,244.27,244.27,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,96.77,32.38,119.79,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,38.9,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
EMERGENCY DEPARTMENT VISIT FOR PROBLEM OF MODERATE SEVERITY,99283,CPT,0450,RC,,,,outpatient,,,1898,189.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,242.94,227.44,245.82,4384,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,895,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1382,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,913,913,1057,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1200,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1500,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,261.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,261.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,269.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,1124.3,643.42,1138.01,187,percent of total billed charges,,,33.6,,669.65,637.73,1138.01,50,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,669.65,637.73,669.65,66,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,261.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,546.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,276.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,996.5,949,996.5,18,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,418.53,255.98,418.53,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,246.57,246.57,246.57,1 through 10,percent of total billed charges,,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,150.22,78.41,246.57,3362,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,261.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,276.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2075,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,266.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,261.25,2075,,facility
PAP TEST; EVALUATION OF FINE NEEDLE ASPIRATE; IMMEDIATE; EACH ADDITIONAL EVALUATION EPISODE,88177,CPT,0311,RC,,,,outpatient,,,130,13,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,41.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,20.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,20.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.86,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,20.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.86,448,,facility
DRUG ASSAY VEDOLIZUMAB,80280,CPT,301,RC,,,,outpatient,,,794,79.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,39.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,38.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,80.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,40.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,38.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,40.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,67.5,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,39.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,38.57,448,,facility
ANTIBODY EVALUATION; INITIAL SINGLE ANTIBODY STAIN PROCEDURE,88346,CPT,0310,RC,,,,outpatient,,,1221,122.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,150.35,150.35,150.35,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,167.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,340.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,172.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,88.73,88.73,88.73,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,172.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,377,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,166.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,163.06,448,,facility
COMPLEMENT ANTIGEN,86160,CPT,302,RC,,,,outpatient,,,195,19.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.67,10.67,10.67,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,87.32,87.32,87.32,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,78.14,49.73,270.86,17,percent of total billed charges,,,33.6,,49.73,49.73,172.37,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,49.73,29.23,50.32,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,256.5,256.5,256.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.67,10.67,10.67,61,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.92,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12,448,,facility
CONT INHLJ TX 1ST HOUR,94644,CPT,410,RC,,,,inpatient,,,450,45,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Short Stay Lesser of + Days Threshold 1.00 + Stoploss First Dollar + Reimbursement Rate 57.00 + Basic Per Diem + Fixed Rate 5000.00 + Fixed Amount 157464.00,,,,0,other,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,Short Stay Lesser of + Days Threshold 1.00 + Stoploss First Dollar + Reimbursement Rate 72.00 + Basic Per Diem + Fixed Rate 10000.00 + Fixed Amount 56687.00,,,,0,other,NTE Percentage + Reimbursement Rate 85.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,47.3,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,facility
CYTOGENETICS 100-300,88275,CPT,311,RC,,,,outpatient,,,863,86.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,45.53,45.53,45.53,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,51.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,51.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,52.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,1828.51,1828.51,1828.51,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,401.18,401.18,401.18,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,51.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,106.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,54.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,45.53,45.53,45.53,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,51.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,54.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,89.58,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,52.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,51.19,448,,facility
ASSAY OF IRON,83540,CPT,301,RC,,,,outpatient,,,453,45.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.75,5.75,5.75,336,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,19.18,19.18,60.77,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,17.42,11.09,54.38,99,percent of total billed charges,,,33.6,,11.09,11.09,54.38,18,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,11.09,11.02,34.61,116,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,13.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,16.5,16.5,16.5,11,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.75,5.75,5.75,876,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.98,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,6.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,6.47,448,,facility
IRON BINDING CAPACITY,83550,CPT,0301,RC,,,,outpatient,,,392,39.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,7.77,7.77,7.77,268,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,231.28,231.28,231.28,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,206.98,131.71,206.98,54,percent of total billed charges,,,33.6,,131.71,131.71,206.98,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,131.71,131.71,132.89,63,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,18.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,9.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,196,196,196,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,7.77,7.77,7.77,697,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,9.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.88,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,8.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,8.74,448,,facility
HIV-1 QUANT&REVRSE TRNSCRPJ,87536,CPT,306,RC,,,,outpatient,,,627,62.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,75.7,75.7,75.7,61,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,115.05,115.05,369.93,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,124.8,124.8,124.8,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,85.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,85.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,87.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,102.96,65.52,102.96,24,percent of total billed charges,,,33.6,,102.96,65.52,331.06,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,65.52,65.52,66.11,15,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,85.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,177.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,90.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,97.5,97.5,97.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,75.7,75.7,75.7,201,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,85.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,90.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,183.86,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,86.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,85.1,448,,facility
LACTATE DEHYDROGENASE (ENZYME) LEVEL,83615,CPT,0301,RC,,,,outpatient,,,55,5.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.37,5.37,5.37,60,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,38.94,38.94,38.94,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,34.85,11.09,34.85,38,percent of total billed charges,,,33.6,,22.18,22.18,22.18,46,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,20.95,20.95,22.18,22,percent of total billed charges,,,34.6,,23.96,20.95,25.15,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,12.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,13.86,13.86,13.86,17,percent of total billed charges,,,35,,27.5,27.5,27.5,1 through 10,percent of total billed charges,,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.37,5.37,5.37,235,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.04,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,6.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,6.04,448,,facility
CULTURE SCREEN ONLY,87081,CPT,306,RC,,,,outpatient,,,432,43.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.9,5.9,5.9,191,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,192.64,5.9,192.64,17,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,277.89,277.89,277.89,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,148.9,101.14,158.93,15,percent of total billed charges,,,33.6,,148.9,101.14,158.93,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,101.14,95.6,101.14,34,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,13.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,7.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,150.5,141,150.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,63.21,63.21,63.21,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.9,5.9,5.9,279,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,7.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.32,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,6.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,6.63,448,,facility
HEMODIALYSIS PROCEDURE WITH PHYSICIAN EVALUATION,90935,CPT,0821,RC,,,,outpatient,,,2442,244.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,613.94,605.88,613.94,23,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,656.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,656.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,676.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,656.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1372.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,696.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,61.36,61.36,61.36,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,656.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,696.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1544,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,669.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1544,,facility
SIMPLE SEPARATION OF FINGERNAIL OR TOENAIL FROM NAIL BED; FIRST NAIL,11730,CPT,0761,RC,,,,outpatient,,,792,79.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,197.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,401.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,203.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,203.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,195.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,192.01,1173,,facility
COLLAGEN CROSSLINKS,82523,CPT,301,RC,,,,outpatient,,,398,39.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,39.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.62,16.62,16.62,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,40.37,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.68,448,,facility
SARSCOV2 VAC 3MCG TRS-SUC IM,91318,CPT,636,RC,,,,outpatient,,,421,42.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare OPPS payment and based on reasonable cost. Payment determination is based on final charges.,,,,0,other,Payer contract is 100.00% of Medicare OPPS payment and based on reasonable cost. Payment determination is based on final charges. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare OPPS payment and based on reasonable cost. Payment determination is based on final charges.,,,,0,other,Payer contract is 100.00% of Medicare OPPS payment and based on reasonable cost. Payment determination is based on final charges. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare OPPS payment and based on reasonable cost. Payment determination is based on final charges.,,,,0,other,Payer contract is 103.00% of Medicare OPPS payment and based on reasonable cost. Payment determination is based on final charges. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare OPPS payment and based on reasonable cost. Payment determination is based on final charges.,,,,0,other,Payer contract is 100.00% of Medicare OPPS payment and based on reasonable cost. Payment determination is based on final charges. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare OPPS payment and based on reasonable cost. Payment determination is based on final charges.,,,,0,other,Payer contract is 209.00% of Medicare OPPS payment and based on reasonable cost. Payment determination is based on final charges. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare OPPS payment and based on reasonable cost. Payment determination is based on final charges.,,,,0,other,Payer contract is 106.00% of Medicare OPPS payment and based on reasonable cost. Payment determination is based on final charges. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare OPPS payment and based on reasonable cost. Payment determination is based on final charges.,,,,0,other,Payer contract is 100.00% of Medicare OPPS payment and based on reasonable cost. Payment determination is based on final charges. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare OPPS payment and based on reasonable cost. Payment determination is based on final charges.,,,,0,other,Payer contract is 106.00% of Medicare OPPS payment and based on reasonable cost. Payment determination is based on final charges. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,140.93,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,Payer contract is 102.00% of Medicare OPPS payment and based on reasonable cost. Payment determination is based on final charges.,,,,0,other,Payer contract is 102.00% of Medicare OPPS payment and based on reasonable cost. Payment determination is based on final charges. + No services performed during 15-month lookback period,140.93,448,,facility
KNEE-SHIN PNEUM/HYDRA PNEUM,L5780,HCPCS,274,RC,,,,outpatient,,,2376,237.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,66,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,61,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1614.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1614.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1663.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1614.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3375.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1711.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1614.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1711.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,1647.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,1614.94,3375.22,,facility
ULTRASOUND OF ABDOMEN AND PELVIS ARTERY AND VEIN BLOOD FLOW,93976,CPT,0921,RC,,,,outpatient,,,1342,134.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,94.7,94.7,94.7,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1227,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,1227,,facility
PROGRAMMING OF PACING CARDIOVERTER-DEFIBRILLATOR,93642,CPT,0480,RC,,,,outpatient,,,7287,728.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2004,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,2759,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,1165.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1165.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1200.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1165.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,2435.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1235.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1165.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1235.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1463,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1188.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,2759,,facility
IMMUNOASSAY QUANT NOS NONAB,83520,CPT,301,RC,,,,outpatient,,,1671,167.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,36,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,66.08,66.08,66.08,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,41.18,24.82,318.38,1 through 10,percent of total billed charges,,,33.6,,37.63,37.63,96.43,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,33.6,23.18,176.4,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,36.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,87,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.22,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.27,448,,facility
ASSAY OF ALDOSTERONE,82088,CPT,301,RC,,,,outpatient,,,313,31.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,36.25,36.25,36.25,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,32.45,32.45,63.72,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,40.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,40.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,41.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,29.04,18.48,29.04,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,18.48,17.81,46.37,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,40.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,85.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,43.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,36.25,36.25,36.25,24,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,40.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,43.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,88.04,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,41.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,40.75,448,,facility
FOOT LONGITUD/METATARSAL SUP,L3020,HCPCS,274,RC,,,,outpatient,,,365,36.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,66,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,61,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,245.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,245.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,252.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,245.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,512.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,259.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,245.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,259.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,250.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,245.12,512.3,,facility
BODY FLUID CELL COUNT,89050,CPT,0300,RC,,,,outpatient,,,424,42.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,271.36,271.36,271.36,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,142.46,142.46,190.38,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,9.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,89.04,89.04,89.04,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.2,4.2,4.2,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.2,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,4.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,4.72,448,,facility
FOOT LONGITUDINAL ARCH SUPPO,L3010,HCPCS,274,RC,,,,outpatient,,,321,32.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,66,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,61,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,215.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,215.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,221.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,215.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,449.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,228.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,215.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,228.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,219.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,215.28,449.94,,facility
ASSAY PROSTATE PHOSPHATASE,84066,CPT,301,RC,,,,outpatient,,,59,5.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,9.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,20.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,9.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.88,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,9.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,9.66,448,,facility
ETOPOSIDE INJECTION,J9181,HCPCS,636,RC,,,,outpatient,,,5,0.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,73.6,60.8,73.6,615,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,52.8,,35.86,31.94,44.13,116,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",448,448,,facility
COLLJ & INTERPJ DATA EA 30 D,99091,CPT,510,RC,,,,outpatient,,,0.01,,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,46.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,46.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,47.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,46.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,96.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,48.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,46.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,48.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,46.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,46.01,448,,facility
X-RAY EXAM OF FOREARM,73090,CPT,320,RC,,,,outpatient,,,1369,136.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,85.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,174.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,17.52,17.52,18.03,76,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,84.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,83.29,448,,facility
MEASUREMENT OF BRAIN WAVE ACTIVITY WITH VIDEO (VEEG); 12-26 HOURS WITH CONTINUOUS MONITORING,95716,CPT,0740,RC,,,,outpatient,,,3534,353.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,892.66,758.08,892.66,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,821.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,821.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,846.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,2145.79,1365.5,2145.79,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,821.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1717.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,871.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,1213.05,1213.05,1213.05,20,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,821.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,871.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1175,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,838.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1717.69,,facility
CLOT FACTOR VIII AHG 1 STAGE,85240,CPT,305,RC,,,,outpatient,,,270,27,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.92,15.92,15.92,48,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,98.21,62.5,349.44,1 through 10,percent of total billed charges,,,33.6,,62.5,62.5,62.5,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,62.88,62.5,62.88,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,37.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,93,92.75,93,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.92,15.92,15.92,80,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.68,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.9,448,,facility
DETECT AGENT NOS DNA AMP,87798,CPT,306,RC,,,,outpatient,,,613,61.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,110.88,110.88,174.24,1 through 10,percent of total billed charges,,,33.6,,244.27,244.27,244.27,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,96.77,32.38,119.79,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,38.9,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
PARTICLE AGGLUT ANTBDY SCRN,86403,CPT,302,RC,,,,outpatient,,,838,83.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,154.18,154.18,154.18,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,24.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.26,10.26,10.26,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.02,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,11.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.54,448,,facility
I&D UPR A/E BURSA,23931,CPT,450,RC,,,,outpatient,,,4318,431.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1628.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3303.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1675.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1675.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1612.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3303.62,,facility
CYTOGENETICS DNA PROBE,88271,CPT,311,RC,,,,outpatient,,,337,33.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.05,19.05,19.05,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,1274.11,1274.11,1274.11,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,477.79,477.79,477.79,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,21.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,44.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.05,19.05,19.05,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,21.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,46.27,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,21.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,21.42,448,,facility
X-RAY OF ABDOMEN; 1 VIEW,74018,CPT,0320,RC,,,,outpatient,,,716,71.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,83.75,83.75,83.75,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,458.24,458.24,458.24,17,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,422.44,422.44,422.44,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,85.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,242.72,240.58,378.05,12,percent of total billed charges,,,33.6,,240.58,240.58,240.58,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,240.58,240.58,242.72,11,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,174.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,358,358,358,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,17.25,17.25,18.03,88,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,84.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,83.29,448,,facility
ALPHA-1-ANTITRYPSIN TOTAL,82103,CPT,301,RC,,,,outpatient,,,202,20.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.95,11.95,11.95,14,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,15.79,11.42,30.1,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,19.15,11.42,48.05,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,28.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.95,11.95,11.95,58,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.03,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.44,448,,facility
BIOPSY OF FRONT 2/3 OF TONGUE,41100,CPT,0761,RC,,,,outpatient,,,1383,138.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,516.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,516.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,531.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,516.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1078.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,547.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,516.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,547.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,526.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1173,,facility
BLOOD TEST; BASIC GROUP OF BLOOD CHEMICALS (CALCIUM; TOTAL),80048,CPT,0301,RC,,,,outpatient,,,752,75.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,7.53,7.53,7.53,173,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,25.96,11.84,443.68,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,28.16,28.16,28.16,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,254.93,23.23,429.39,147,percent of total billed charges,,,33.6,,252.67,14.78,429.39,26,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,14.92,14.78,252.67,149,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,17.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,22,22,376,21,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,9.24,9.24,157.92,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,7.53,7.53,7.53,1135,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.27,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,8.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,8.46,448,,facility
BELOW KNEE TOTAL CONTACT,L5637,HCPCS,274,RC,,,,outpatient,,,701,70.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,66,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,61,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,471.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,471.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,485.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,471.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,985.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,499.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,471.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,499.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,480.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,471.56,985.56,,facility
CULTURE SCREEN ONLY,87081,CPT,306,RC,,,,outpatient,,,564,56.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.9,5.9,5.9,191,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,192.64,5.9,192.64,17,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,277.89,277.89,277.89,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,148.9,101.14,158.93,15,percent of total billed charges,,,33.6,,148.9,101.14,158.93,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,101.14,95.6,101.14,34,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,13.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,7.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,150.5,141,150.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,63.21,63.21,63.21,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.9,5.9,5.9,279,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,7.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.32,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,6.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,6.63,448,,facility
ASSAY OF GASTRIN,82941,CPT,301,RC,,,,outpatient,,,64,6.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,36.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.68,15.68,15.68,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.1,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.63,448,,facility
URINE POTASSIUM LEVEL,84133,CPT,0301,RC,,,,outpatient,,,67,6.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.21,4.21,4.21,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,22.51,22.51,22.71,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,9.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,9.5,9.5,33.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.21,4.21,4.21,20,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.31,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,4.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,4.73,448,,facility
IMMUNOASSAY TUMOR OTHER,86316,CPT,302,RC,,,,outpatient,,,954,95.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,18.51,18.51,18.51,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,76.03,32.21,76.03,1 through 10,percent of total billed charges,,,33.6,,48.38,48.38,48.38,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,20.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,43.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,18.51,18.51,18.51,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,20.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,44.98,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,21.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,20.81,448,,facility
DPYD GENE COMMON VARIANTS,81232,CPT,310,RC,,,,outpatient,,,990,99,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,174.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,174.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,180.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,174.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,365.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,185.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,174.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,185.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,305.92,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,178.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,174.81,448,,facility
DETECT AGENT NOS DNA AMP,87798,CPT,306,RC,,,,outpatient,,,96,9.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,110.88,110.88,174.24,1 through 10,percent of total billed charges,,,33.6,,244.27,244.27,244.27,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,96.77,32.38,119.79,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,38.9,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
TEST TO DETERMINE LUNG VOLUMES USING GAS DILUTION OR WASHOUT,94727,CPT,0460,RC,,,,outpatient,,,455,45.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,291.2,291.2,378.88,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,206.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,206.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,212.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,312.58,198.91,312.58,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,154.25,154.25,154.25,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,206.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,431.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,219.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,26.96,26.96,27.47,11,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,206.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,219.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,611,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,210.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,206.65,611,,facility
HISTOPLASMA ANTIBODY,86698,CPT,302,RC,,,,outpatient,,,189,18.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.27,12.27,12.27,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,28.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.27,12.27,12.27,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.79,448,,facility
PROS SHEATH/SOCK W GEL CUSHN,L8417,HCPCS,274,RC,,,,outpatient,,,138,13.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,66,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,61,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,93.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,93.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,95.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,93.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,194.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,98.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,93.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,98.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,94.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,93.09,194.56,,facility
X-RAY OF FOREARM; 2 VIEWS,73090,CPT,0320,RC,,,,outpatient,,,732,73.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,85.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,174.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,17.52,17.52,18.03,76,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,84.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,83.29,448,,facility
AMYLASE (ENZYME) LEVEL,82150,CPT,0301,RC,,,,outpatient,,,80,8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.76,5.76,5.76,19,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,95,95,95,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,54.24,31.92,54.25,46,percent of total billed charges,,,33.6,,31.92,27.12,54.24,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,31.92,27.12,31.92,11,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,13.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,40,40,47.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.76,5.76,5.76,306,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,6.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,6.48,448,,facility
UNLISTED CHEMISTRY PROCEDURE,84999,CPT,301,RC,,,,outpatient,,,6332,633.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
ANALYSIS USING CHEMILUMINESCENT TECHNIQUE (LIGHT AND CHEMICAL )REACTION,82397,CPT,0301,RC,,,,outpatient,,,423,42.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.56,12.56,12.56,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,22.85,22.85,22.85,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,29.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.56,12.56,12.56,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.5,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.12,448,,facility
TOXOPLASMA ANTIBODY IGM,86778,CPT,302,RC,,,,outpatient,,,272,27.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.82,12.82,12.82,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,30.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.82,12.82,12.82,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,31.12,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.41,448,,facility
ARSENIC LEVEL,82175,CPT,0301,RC,,,,outpatient,,,88,8.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.87,16.87,16.87,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,39.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,20.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.87,16.87,16.87,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,20.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,40.99,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.97,448,,facility
NFCT AGT GNTYP ALYS HIV1 REV,87901,CPT,306,RC,,,,outpatient,,,1134,113.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,295,295,295,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,257.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,257.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,265.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,264,264,264,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,257.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,538.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,272.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,229,229,229,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,257.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,272.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,556.22,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,262.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,257.45,556.22,,facility
CT SCAN OF ABDOMINAL AORTA AND BOTH LEG ARTERIES WITH CONTRAST,75635,CPT,0350,RC,,,,outpatient,,,10165,1016.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,411.15,411.15,411.15,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,875,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1050,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,172.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,350.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,177.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,177.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1522,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,171.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,167.87,1522,,facility
T CELL ABSOLUTE COUNT,86361,CPT,302,RC,,,,outpatient,,,785,78.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,23.82,23.82,23.82,46,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,160.48,160.19,463.15,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,143.62,91.39,143.62,24,percent of total billed charges,,,33.6,,143.62,91.39,414.48,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,91.39,91.39,92.04,15,percent of total billed charges,,,34.6,,284.95,284.95,284.95,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,26.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,55.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,28.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,136,135.75,136,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,23.82,23.82,23.82,197,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,26.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,28.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,57.86,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,27.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,26.78,448,,facility
MOPATH PROCEDURE LEVEL 7,81406,CPT,310,RC,,,,outpatient,,,744,74.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,282.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,282.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,291.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,282.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,591.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,299.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,282.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,299.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,495.04,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,288.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,282.88,591.22,,facility
DRAINAGE OF ABSCESS NEAR TONSIL,42700,CPT,0450,RC,,,,outpatient,,,1742,174.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,209.09,203.75,213.28,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,226.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,226.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,233.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,994.68,994.68,994.68,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,226.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,473.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,240.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,206.8,206.8,213.28,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,226.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,240.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,231.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,226.68,1173,,facility
AK 4 BAR LING W/HYDRAUL SWIG,L5613,HCPCS,274,RC,,,,outpatient,,,4508,450.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,66,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,61,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Stoploss First Dollar + Reimbursement Rate 50.00 + Percent Of Charge + Reimbursement Rate 0.00 + Fixed Amount 3149.00,,,,0,other,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,Stoploss First Dollar + Reimbursement Rate 50.00 + Percent Of Charge + Reimbursement Rate 0.00 + Fixed Amount 3149.00,,,,0,other,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,3038.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3038.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3129.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3038.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,6349.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3220.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3038.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3220.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,3098.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,3038.19,6349.82,,facility
SYMES TYPE MEDIAL OPENING SO,L5636,HCPCS,274,RC,,,,outpatient,,,460,46,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,66,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,61,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,311.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,311.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,321.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,311.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,651.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,330.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,311.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,330.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,318.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,311.94,651.95,,facility
BLOOD CHLORIDE LEVEL,82435,CPT,0301,RC,,,,outpatient,,,58,5.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,9.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.09,4.09,4.09,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.94,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,4.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,4.6,448,,facility
LYMPHOCYTE TRANSFORMATION,86353,CPT,302,RC,,,,outpatient,,,790,79,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,49.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,49.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,50.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,49.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,102.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,51.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,49.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,51.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,105.93,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,50.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,49.03,448,,facility
SYPHILIS TEST NON-TREP QUAL,86592,CPT,302,RC,,,,outpatient,,,137,13.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.8,3.8,3.8,262,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,28.8,3.16,28.8,20,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,26.55,26.4,79.65,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,28.8,28.8,28.8,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,23.76,15.12,23.76,39,percent of total billed charges,,,33.6,,15.17,15.12,45.36,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,15.12,15.12,15.17,34,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,8.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,22.38,22.38,22.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.8,3.8,3.8,282,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.22,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,4.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,4.27,448,,facility
HZV VACC RECOMBINANT IM,90750,CPT,636,RC,,,,outpatient,,,0.01,,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,0.01,0.01,0.01,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,579.29,579.29,579.29,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,0.01,0.01,201.78,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
LANREOTIDE INJECTION,J1930,HCPCS,636,RC,,,,outpatient,,,345,34.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,37.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,37.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,78.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,39.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,39.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,96.71,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,38.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,37.43,448,,facility
MOG-IGG1 ANTB FLO CYTMTRY EA,86363,CPT,302,RC,,,,outpatient,,,2192,219.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,33.56,33.56,33.56,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,37.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,37.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,449.23,449.23,705.94,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,453.24,453.24,453.24,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,78.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,39.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,33.56,33.56,33.56,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,39.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.09,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,38.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,21.09,448,,facility
ASSAY OF SOMATOMEDIN,84305,CPT,301,RC,,,,outpatient,,,271,27.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,18.91,18.91,18.91,22,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,46.61,46.61,46.61,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,41.71,26.54,154.74,1 through 10,percent of total billed charges,,,33.6,,91.06,26.54,143.09,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,91.06,26.54,91.06,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,21.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,44.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,39.5,39.5,39.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,18.91,18.91,18.91,57,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,21.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,45.94,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,21.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,21.26,448,,facility
MOPATH PROCEDURE LEVEL 8,81407,CPT,310,RC,,,,outpatient,,,2100,210,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,846.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,846.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,871.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,846.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1768.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,897.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,846.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,897.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1480.97,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,863.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1768.7,,facility
INJECTION FOR IMAGING OF AORTA ABOVE HEART VALVE WITH REVIEW BY RADIOLOGIST,93567,CPT,0480,RC,,,,outpatient,,,3081,308.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,30.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,31.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,1035.22,1035.22,1035.22,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,30.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,64.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,32.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,30.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,32.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1463,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,31.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,30.74,1463,,facility
EPSTEIN-BARR CAPSID VCA,86665,CPT,302,RC,,,,outpatient,,,559,55.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.14,16.14,16.14,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,106.24,61.44,106.24,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,87.65,87.65,759.96,1 through 10,percent of total billed charges,,,33.6,,345.41,345.41,345.41,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,65.86,65.86,345.41,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,37.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.14,16.14,16.14,21,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,39.2,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.14,448,,facility
RBC SERUM PRETX INCUBJ DRUGS,86975,CPT,302,RC,,,,outpatient,,,150,15,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,427.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,427.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,440.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,427.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,893.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,453.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,427.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,453.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,55.65,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,436.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,55.65,893.56,,facility
NUCLEAR ANTIGEN ANTIBODY,86235,CPT,302,RC,,,,outpatient,,,400,40,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13,12.5,15.95,11,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,54.91,4.37,90.29,43,percent of total billed charges,,,33.6,,4.37,4.37,53.09,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,22.18,4.24,83.33,13,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,37.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.95,13,15.95,54,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.75,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.93,448,,facility
DETECT AGENT NOS DNA AMP,87798,CPT,306,RC,,,,outpatient,,,85,8.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,110.88,110.88,174.24,1 through 10,percent of total billed charges,,,33.6,,244.27,244.27,244.27,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,96.77,32.38,119.79,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,38.9,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
ASSAY OF COPPER,82525,CPT,301,RC,,,,outpatient,,,177,17.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.04,11.04,11.04,18,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,35.64,22.85,35.9,1 through 10,percent of total billed charges,,,33.6,,80.64,80.64,80.64,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,22.85,19.49,22.85,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,50.4,50.4,50.4,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.04,11.04,11.04,37,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.81,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.41,448,,facility
IGE (IMMUNE SYSTEM PROTEIN) LEVEL,82785,CPT,0301,RC,,,,outpatient,,,84.75,8.48,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,14.64,14.64,14.64,32,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,44.88,28.56,175.87,1 through 10,percent of total billed charges,,,33.6,,124.52,124.52,124.52,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,28.56,28.56,28.56,1 through 10,percent of total billed charges,,,34.6,,32.29,32.29,117.35,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,34.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,14.64,14.64,14.64,106,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.56,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,16.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,16.46,448,,facility
RED BLOOD CELL CONCENTRATION MEASUREMENT,85014,CPT,0300,RC,,,,outpatient,,,123,12.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,4.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.13,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,2.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,2.37,448,,facility
X-RAY OF JOINT BETWEEN LOWER SPINE AND HIP BONE; 3 OR MORE VIEWS,72202,CPT,0320,RC,,,,outpatient,,,1451,145.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,928.64,928.64,928.64,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,487.54,487.54,487.54,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,448,,facility
QUANTITATIVE ASSAY DRUG,80299,CPT,301,RC,,,,outpatient,,,350,35,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,13,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,174.64,174.64,174.64,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,171.6,171.6,171.6,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,374.52,374.52,374.52,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.62,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.64,448,,facility
CARNITINE LEVEL,82379,CPT,0301,RC,,,,outpatient,,,179,17.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.01,15.01,15.01,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,191.14,191.14,191.14,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,35.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.01,15.01,15.01,15,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.45,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,16.87,448,,facility
GENOME SEQUENCE ANALYSIS,81426,CPT,310,RC,,,,outpatient,,,4226,422.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2709.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2709.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2791.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2709.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,5663.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2872.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2709.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2872.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4742.41,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,2764.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,5663.8,,facility
DEHYDROEPIANDROSTERONE,82627,CPT,301,RC,,,,outpatient,,,269,26.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.77,19.77,19.77,24,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,44.25,44.25,44.25,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,39.6,39.6,142.03,1 through 10,percent of total billed charges,,,33.6,,25.2,25.2,25.2,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,25.2,25.2,90.38,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,46.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,23.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.77,19.77,19.77,42,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,23.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,48.04,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,22.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,22.23,448,,facility
IMMUNFIX E-PHORSIS/URINE/CSF,86335,CPT,302,RC,,,,outpatient,,,71,7.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,26.11,26.11,26.11,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,25.76,25.76,25.76,1 through 10,percent of total billed charges,,,34.6,,56.99,56.99,56.99,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,29.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,61.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,31.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,26.11,26.11,26.11,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,29.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,31.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,63.4,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,29.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,29.35,448,,facility
T CELL ABSOLUTE COUNT,86361,CPT,302,RC,,,,outpatient,,,448,44.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,23.82,23.82,23.82,46,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,160.48,160.19,463.15,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,143.62,91.39,143.62,24,percent of total billed charges,,,33.6,,143.62,91.39,414.48,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,91.39,91.39,92.04,15,percent of total billed charges,,,34.6,,284.95,284.95,284.95,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,26.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,55.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,28.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,136,135.75,136,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,23.82,23.82,23.82,197,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,26.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,28.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,57.86,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,27.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,26.78,448,,facility
MOPATH PROCEDURE LEVEL 6,81405,CPT,310,RC,,,,outpatient,,,1390,139,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,301.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,301.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,310.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,301.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,629.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,319.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,301.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,319.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,527.36,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,307.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,301.35,629.82,,facility
BETA-2 GLYCOPROTEIN ANTIBODY,86146,CPT,302,RC,,,,outpatient,,,327,32.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,22.64,22.64,22.64,11,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,90.82,24.82,293.57,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,57.79,57.79,186.82,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,25.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,53.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,26.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,128.1,128.1,128.1,1 through 10,percent of total billed charges,,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,22.64,22.64,22.64,25,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,25.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,26.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,54.99,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,25.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,25.45,448,,facility
HPV HI-RISK TYP POOLED RSLT,87624,CPT,306,RC,,,,outpatient,,,321,32.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,51,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,57.23,57.23,57.23,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,85.34,51.22,134.11,1 through 10,percent of total billed charges,,,33.6,,32.59,32.59,85.34,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,85.34,75.94,85.34,14,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,112,48.5,112,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,20.37,20.37,53.34,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,80,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
SHAVE SKIN LESION 0.5 CM/<,11300,CPT,761,RC,,,,outpatient,,,1742,174.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,400.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,813.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,412.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,412.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,396.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,389.05,813.11,,facility
THROMBOPLASTIN TIME PARTIAL,85730,CPT,305,RC,,,,outpatient,,,40,4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.35,5.35,5.35,44,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,17.28,17.28,226.56,25,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,208.86,15.93,208.86,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,186.91,11.69,202.13,44,percent of total billed charges,,,33.6,,118.94,9.07,237.89,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,118.94,9.07,120.01,25,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,12.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,177,13.5,177,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.35,5.35,5.35,310,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.99,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,6.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,6.01,448,,facility
PARATHORMONE (PARATHYROID HORMONE) LEVEL,83970,CPT,0301,RC,,,,outpatient,,,397,39.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,36.72,36.72,36.72,87,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,67.85,67.85,67.85,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,41.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,41.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,60.72,38.64,209.62,23,percent of total billed charges,,,33.6,,38.64,38.64,38.64,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,38.99,38.64,134.58,39,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,41.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,86.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,43.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,83.37,83.37,83.37,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,36.72,36.72,36.72,244,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,41.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,43.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,89.18,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,42.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,41.28,448,,facility
ASSAY OF AMYLASE,82150,CPT,301,RC,,,,outpatient,,,124,12.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.76,5.76,5.76,19,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,95,95,95,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,54.24,31.92,54.25,46,percent of total billed charges,,,33.6,,31.92,27.12,54.24,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,31.92,27.12,31.92,11,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,13.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,40,40,47.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.76,5.76,5.76,306,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,6.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,6.48,448,,facility
CETUXIMAB INJECTION,J9055,HCPCS,636,RC,,,,outpatient,,,254,25.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,81.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,81.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,84.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,81.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,170.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,86.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,81.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,86.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,165.77,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,83.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,81.67,448,,facility
REVIEW BY RADIOLOGIST OF URINARY BLADDER AND URETHRA IMAGES WITH CONTRAST AND AFTER PASSING URINE,74455,CPT,0320,RC,,,,outpatient,,,813,81.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,520.32,520.32,520.32,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,235.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,429.26,273.17,429.26,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,477.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,242.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,406.5,406.5,406.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,242.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,232.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,228.36,477.27,,facility
CYTOGENETICS DNA PROBE,88271,CPT,311,RC,,,,outpatient,,,451,45.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.05,19.05,19.05,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,1274.11,1274.11,1274.11,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,477.79,477.79,477.79,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,21.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,44.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.05,19.05,19.05,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,21.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,46.27,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,21.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,21.42,448,,facility
MRI SCAN OF LEG JOINT WITHOUT CONTRAST,73721,CPT,0610,RC,,,,outpatient,,,5616,561.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,786,,,,,,,case rate,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,728,,,,,,,case rate,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1025,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1350,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,235.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,477.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,242.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,242.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2407,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,232.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,228.36,2407,,facility
GENE ANALYSIS (V-KIT HARDY-ZUCKERMAN 4 FELINE SARCOMA VIRAL ONCOGENE HOMOLOG); D816 VARIANTS,81273,CPT,0310,RC,,,,outpatient,,,1069,106.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,111.07,111.07,111.07,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,124.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,124.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,128.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,124.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,260.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,132.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,111.07,111.07,111.07,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,124.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,132.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,218.52,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,127.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,124.87,448,,facility
LACTOFERRIN FECAL (QUANT),83631,CPT,301,RC,,,,outpatient,,,357,35.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,41.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,20.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,20.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.42,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,20.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,19.63,448,,facility
ASSESSMENT OF AND CARE PLANNING FOR IMPAIRED THOUGHT PROCESSING; TYPICALLY 50 MINUTES,99483,CPT,0510,RC,,,,outpatient,,,230,23,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,89.68,81.16,97.23,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,97.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,97.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,97.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,203.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,97.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,99.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,97.23,448,,facility
DRUG SCREENING BARBITURATES,80345,CPT,301,RC,,,,outpatient,,,339,33.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
BODY FLUID CELL COUNT WITH CELL IDENTIFICATION,89051,CPT,0309,RC,,,,outpatient,,,561,56.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,503.78,376.99,592.42,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,11.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.98,4.98,4.98,47,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.9,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.6,448,,facility
UNLISTED MOLECULAR PATHOLOGY,81479,CPT,310,RC,,,,outpatient,,,1160,116,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,561.56,561.56,561.56,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,32.5,32.5,3071.5,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
AFO POS SOLID ANK PLASTIC MO,L1960,HCPCS,274,RC,,,,outpatient,,,945,94.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,66,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,61,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,636.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,636.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,656.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,636.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1331.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,675.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,636.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,675.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,649.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,636.95,1331.23,,facility
AMINOLEVULINIC ACID HCL TOP,J7308,HCPCS,636,RC,,,,outpatient,,,815,81.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,389.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,389.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,400.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,389.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,813.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,412.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,389.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,412.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,849.81,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,397.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,389.28,849.81,,facility
SIMPLE CLOSURE OF SURFACE WOUND REOPENING,12020,CPT,0450,RC,,,,outpatient,,,783,78.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,707.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,707.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,728.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,707.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1478.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,749.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,665.54,665.54,665.54,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,707.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,749.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,721.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1478.34,,facility
HIV-1 QUANT&REVRSE TRNSCRPJ,87536,CPT,306,RC,,,,outpatient,,,990,99,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,75.7,75.7,75.7,61,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,115.05,115.05,369.93,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,124.8,124.8,124.8,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,85.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,85.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,87.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,102.96,65.52,102.96,24,percent of total billed charges,,,33.6,,102.96,65.52,331.06,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,65.52,65.52,66.11,15,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,85.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,177.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,90.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,97.5,97.5,97.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,75.7,75.7,75.7,201,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,85.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,90.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,183.86,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,86.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,85.1,448,,facility
FLUORESCENT ANTIBODY TITER,86256,CPT,302,RC,,,,outpatient,,,264,26.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.72,10.72,10.72,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.04,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.05,448,,facility
QUANTITATIVE ASSAY DRUG,80299,CPT,301,RC,,,,outpatient,,,585,58.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,13,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,174.64,174.64,174.64,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,171.6,171.6,171.6,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,374.52,374.52,374.52,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.62,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.64,448,,facility
UNLISTED MOLECULAR PATHOLOGY,81479,CPT,310,RC,,,,outpatient,,,1313,131.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,561.56,561.56,561.56,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,32.5,32.5,3071.5,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
ADMINISTRATION OF CHEMOTHERAPY INTO VEIN; 1 HOUR OR LESS,96413,CPT,0335,RC,,,,outpatient,,,1010,101,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,291.03,272.45,297.44,965,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,646.4,646.4,646.4,186,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,595.9,441.71,595.9,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,316.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,316.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,325.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,533.28,339.36,533.28,179,percent of total billed charges,,,33.6,,339.36,339.36,533.28,48,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,339.36,339.36,342.39,112,percent of total billed charges,,,34.6,,373.7,373.7,384.81,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,316.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,660.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,335.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,505,505,505,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,212.1,212.1,212.1,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,295.37,295.37,297.44,776,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,316.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,335.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1603,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,322.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,316.12,1603,,facility
THYROGLOBULIN ANTIBODY,86800,CPT,302,RC,,,,outpatient,,,236,23.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,14.15,14.15,14.15,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,19.47,19.47,92.63,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,17.42,11.09,82.9,1 through 10,percent of total billed charges,,,33.6,,41.02,41.02,52.75,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,41.02,11.09,52.75,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,33.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,14.15,14.15,14.15,30,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,34.37,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,16.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,15.91,448,,facility
UNLISTED MOLECULAR PATHOLOGY,81479,CPT,310,RC,,,,outpatient,,,3728,372.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,561.56,561.56,561.56,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,32.5,32.5,3071.5,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
EXTREMITY STUDY,93971,CPT,921,RC,,,,outpatient,,,2979,297.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1227,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,1227,,facility
IMFLUOR 1ST 1ANTB STAIN PX,88346,CPT,310,RC,,,,outpatient,,,438,43.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,150.35,150.35,150.35,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,167.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,340.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,172.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,88.73,88.73,88.73,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,172.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,377,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,166.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,163.06,448,,facility
AMIKACIN (ANTIBIOTIC) LEVEL,80150,CPT,0301,RC,,,,outpatient,,,235,23.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,31.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.57,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,15.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,15.08,448,,facility
IMFLUOR 1ST 1ANTB STAIN PX,88346,CPT,310,RC,,,,outpatient,,,170,17,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,150.35,150.35,150.35,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,167.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,340.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,172.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,88.73,88.73,88.73,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,172.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,377,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,166.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,163.06,448,,facility
USE OF A DRUG TO INDUCE DEPRESSION OF CONSCIOUSNESS BY PHYSICIAN PERFORMING A PROCEDURE (YOUNGER THAN 5 YEARS); INITIAL 15 MINUTES,99151,CPT,0370,RC,,,,outpatient,,,873,87.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",448,448,,facility
LYME DISEASE ANTIBODY,86618,CPT,302,RC,,,,outpatient,,,144,14.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,35.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.15,15.15,15.15,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.79,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.03,448,,facility
VIRUS ANTIBODY NOS,86790,CPT,302,RC,,,,outpatient,,,143,14.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.46,11.46,11.46,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,107.86,20.06,169.49,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,116.52,40.29,122.3,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,26.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.46,11.46,11.46,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.88,448,,facility
COL CHROMOTOGRAPHY QUAL/QUAN,82542,CPT,301,RC,,,,outpatient,,,380,38,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,21.43,21.43,21.43,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,435.07,435.07,435.07,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,24.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,50.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,25.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,21.43,21.43,21.43,15,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,24.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,25.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.16,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,24.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,24.09,448,,facility
BRAF GENE,81210,CPT,310,RC,,,,outpatient,,,593,59.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,156.02,156.02,156.02,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,175.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,175.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,180.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,175.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,366.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,185.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,156.02,156.02,156.02,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,175.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,185.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,306.95,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,178.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,175.4,448,,facility
CHLAMYDIA ANTIBODY,86631,CPT,302,RC,,,,outpatient,,,180,18,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,24.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.55,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.82,448,,facility
IMMUNODIFFUSION OUCHTERLONY,86331,CPT,302,RC,,,,outpatient,,,65,6.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.66,10.66,10.66,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.88,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.98,448,,facility
GENOME-WIDE MICROARRAY ANALYSIS FOR COPY NUMBER AND SINGLE NUCLEOTIDE POLYMORPHISM (SNP) VARIANTS,81229,CPT,0310,RC,,,,outpatient,,,6914,691.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,1031.8,1031.8,1031.8,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1160,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1160,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1194.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,1457.28,1457.28,1457.28,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,2671.54,2671.54,2671.54,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1160,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,2424.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1229.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,1031.8,1031.8,1031.8,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1160,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1229.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2030,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1183.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,2424.4,,facility
ASSAY OF PHENYTOIN TOTAL,80185,CPT,301,RC,,,,outpatient,,,586,58.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,70.22,70.22,70.22,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,44.69,44.69,44.69,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.79,11.79,11.79,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.63,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.25,448,,facility
FLUORESCENT ANTIBODY TITER,86256,CPT,302,RC,,,,outpatient,,,1466,146.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.72,10.72,10.72,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.04,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.05,448,,facility
RUBELLA ANTIBODY,86762,CPT,302,RC,,,,outpatient,,,154,15.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.8,12.8,12.8,18,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,28.32,28.32,28.32,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,25.34,16.13,25.34,14,percent of total billed charges,,,33.6,,16.13,16.13,16.13,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,16.13,16.13,16.27,22,percent of total billed charges,,,34.6,,68.61,68.61,68.61,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,30.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,24,24,44.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,12.8,12.8,12.8,1 through 10,percent of total billed charges,,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.8,12.8,12.8,185,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,31.1,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.39,448,,facility
QUANTITATIVE ASSAY DRUG,80299,CPT,301,RC,,,,outpatient,,,353,35.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,13,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,174.64,174.64,174.64,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,171.6,171.6,171.6,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,374.52,374.52,374.52,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.62,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.64,448,,facility
X-RAY OF MIDDLE AND LOWER SPINE; 2 VIEWS,72080,CPT,0320,RC,,,,outpatient,,,240,24,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,85.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,174.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,20.53,20.53,20.53,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,84.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,83.29,448,,facility
VIT D 1 25-DIHYDROXY,82652,CPT,301,RC,,,,outpatient,,,295,29.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,34.25,34.25,34.25,16,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,30.68,30.68,30.68,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,39.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,41.71,17.47,46.99,1 through 10,percent of total billed charges,,,33.6,,17.47,17.47,29.9,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,26.78,26.54,26.78,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,38.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,80.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,40.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,39.5,39.5,39.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,34.25,34.25,34.25,35,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,38.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,40.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.18,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,39.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,38.5,448,,facility
SPECIAL MEDICAL RADIATION THERAPY CONSULTATION,77370,CPT,0333,RC,,,,outpatient,,,2160,216,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,128.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,128.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,132.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,128.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,268.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,136.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,128.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,136.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,48815,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,131.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,128.64,48815,,facility
HEMOGLOBIN CHROMOTOGRAPHY,83021,CPT,301,RC,,,,outpatient,,,684,68.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.06,16.06,16.06,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,37.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,58.38,58.38,58.38,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.06,16.06,16.06,16,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,39.01,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.06,448,,facility
HEART RHYTHM RECORDING OF CONTINOUS EXTERNAL EKG OVER 8-15 DAYS,93246,CPT,0730,RC,,,,outpatient,,,200,20,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,34.44,34.44,34.44,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,128,128,128,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,118,118,118,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,67.2,67.2,67.2,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,67.2,67.2,67.2,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,74.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9.42,9.42,9.42,14,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,389,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,36.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.74,448,,facility
NUCLEAR ANTIGEN ANTIBODY,86235,CPT,302,RC,,,,outpatient,,,297,29.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13,12.5,15.95,11,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,54.91,4.37,90.29,43,percent of total billed charges,,,33.6,,4.37,4.37,53.09,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,22.18,4.24,83.33,13,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,37.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.95,13,15.95,54,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.75,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.93,448,,facility
RBC SICKLE CELL TEST,85660,CPT,305,RC,,,,outpatient,,,387,38.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.9,4.9,4.9,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,89.04,89.04,139.92,1 through 10,percent of total billed charges,,,33.6,,139.92,139.92,139.92,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,96.19,18.19,100.96,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,11.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,81.27,81.27,105.04,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.9,4.9,4.9,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.9,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.51,448,,facility
"INJECTION, AVELUMAB, 10 MG",J9023,HCPCS,636,RC,,,,outpatient,,,321,32.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,108.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,108.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,111.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,108.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,227.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,115.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,108.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,115.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,208.44,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,110.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,108.64,448,,facility
DETECT AGENT NOS DNA AMP,87798,CPT,306,RC,,,,outpatient,,,51,5.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,110.88,110.88,174.24,1 through 10,percent of total billed charges,,,33.6,,244.27,244.27,244.27,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,96.77,32.38,119.79,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,38.9,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
DRUG SCREENING METHADONE,80358,CPT,301,RC,,,,outpatient,,,339,33.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
BODY JACKET MOLD TO PATIENT,L1300,HCPCS,274,RC,,,,outpatient,,,3283,328.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,66,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,61,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Stoploss First Dollar + Reimbursement Rate 50.00 + Percent Of Charge + Reimbursement Rate 0.00 + Fixed Amount 3149.00,,,,0,other,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,Stoploss First Dollar + Reimbursement Rate 50.00 + Percent Of Charge + Reimbursement Rate 0.00 + Fixed Amount 3149.00,,,,0,other,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,2212.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2212.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2278.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2212.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,4624.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2345.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2212.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2345.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,2256.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,2212.58,4624.29,,facility
CHEMICAL RECEPTOR ANALYSIS,84238,CPT,0301,RC,,,,outpatient,,,105,10.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,37.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,36.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,76.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,38.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,36.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,38.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,79,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,37.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,36.57,448,,facility
HEAVY METAL QUAN EACH NES,83018,CPT,301,RC,,,,outpatient,,,317,31.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,21.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,45.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,23.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,21.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,23.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,47.46,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,22.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,21.96,448,,facility
MOPATH PROCEDURE LEVEL 6,81405,CPT,310,RC,,,,outpatient,,,1955,195.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,301.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,301.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,310.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,301.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,629.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,319.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,301.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,319.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,527.36,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,307.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,301.35,629.82,,facility
INITIAL NEW PATIENT PREVENTIVE MEDICINE EVALUATION (12-17 YEARS),99384,CPT,0770,RC,,,,outpatient,,,594,59.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,85.09,85.09,85.09,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
CYTOMEG DNA AMP PROBE,87496,CPT,306,RC,,,,outpatient,,,1011,101.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
INJ. FE DERISOMALTOSE 10 MG,J1437,HCPCS,636,RC,,,,outpatient,,,136,13.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,21.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,21.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,44.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,21.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,44.66,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,21.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,21.08,448,,facility
NUCLEAR MEDICINE STUDY OF HEART MUSCLE WITH METABOLIC EVALUATION AND CONCURRENT CT SCAN,78429,CPT,0404,RC,,,,outpatient,,,4109,410.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,403,,,,,,,case rate,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,371,,,,,,,case rate,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,2885,2885,2885,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1900,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,2400,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1368.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1368.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1409.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1368.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,2860.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1450.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1368.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1450.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5390,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1395.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,371,5390,,facility
LEUPROLIDE ACETATE /3.75 MG,J1950,HCPCS,636,RC,,,,outpatient,,,4612,461.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,1841.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1841.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1896.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1841.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3848.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1951.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1841.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1951.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3583.58,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1878.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3848.23,,facility
ACTH STIMULATION PANEL,80400,CPT,301,RC,,,,outpatient,,,36,3.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,29.02,29.02,29.02,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,33.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,59.14,59.14,63.95,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,32.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,68.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,34.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,29.02,29.02,29.02,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,32.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,34.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,70.47,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,33.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,32.62,448,,facility
SO/HL 51/>GSAP DNA/DNA&RNA,81455,CPT,310,RC,,,,outpatient,,,3325,332.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2919.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2919.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3007.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2919.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,6101.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3094.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2919.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3094.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5109.3,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,2977.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,6101.96,,facility
REPAIR FOREARM TENDON/MUSCLE,25260,CPT,450,RC,,,,outpatient,,,3855.04,385.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1268,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1793,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3131.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3131.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3225.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3131.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,6544.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3319.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3131.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3319.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3194.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,6544.81,,facility
REVIEW BY RADIOLOGIST OF MAJOR UPPER BODY VEIN IMAGE,75827,CPT,0320,RC,,,,outpatient,,,5938,593.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,1362.99,1362.99,4550.64,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1506.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1506.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1551.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1506.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3148.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1596.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1506.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1596.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1536.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,443,3148.69,,facility
MOLECULAR PATHOLOGY PROCEDURE LEVEL 2,81401,CPT,0310,RC,,,,outpatient,,,2684,268.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,121.86,121.86,121.86,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,137,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,137,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,141.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,137,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,286.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,145.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,137,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,145.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,239.75,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,139.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,137,448,,facility
SPECIMEN HANDLING PT-LAB,99001,CPT,300,RC,,,,outpatient,,,1,0.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.71,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,10.71,448,,facility
INIT PM E/M NEW PAT 65+ YRS,99387,CPT,770,RC,,,,outpatient,,,569,56.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
ASSAY OF VITAMIN E,84446,CPT,301,RC,,,,outpatient,,,39.85,3.99,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.61,12.61,12.61,23,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,31.68,15.12,31.68,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,20.16,17.81,20.16,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,29.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.61,12.61,12.61,61,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.64,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.18,448,,facility
ANALGESICS NON-OPIOID 1 OR 2,80329,CPT,301,RC,,,,outpatient,,,12,1.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
CANNABINOIDS NATURAL,80349,CPT,301,RC,,,,outpatient,,,39.75,3.98,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
QUANTITATIVE ASSAY DRUG,80299,CPT,301,RC,,,,outpatient,,,145,14.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,13,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,174.64,174.64,174.64,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,171.6,171.6,171.6,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,374.52,374.52,374.52,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.62,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.64,448,,facility
FLUORESCENT ANTIBODY SCREEN,86255,CPT,302,RC,,,,outpatient,,,141.75,14.18,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.72,10.72,10.72,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,45.41,28.9,1068.67,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,28.9,28.9,28.9,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.72,10.72,10.72,19,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.04,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.05,448,,facility
ASSAY OF SWEAT SODIUM,84302,CPT,301,RC,,,,outpatient,,,8,0.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,10.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.5,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,4.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,4.86,448,,facility
TEST FOR G6PD ENZYME,82960,CPT,301,RC,,,,outpatient,,,12,1.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,36.43,36.43,36.43,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,12.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.38,5.38,5.38,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.07,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,6.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,6.05,448,,facility
DRUG SCREENING METHADONE,80358,CPT,301,RC,,,,outpatient,,,40,4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
ASSAY OF BIOTINIDASE,82261,CPT,301,RC,,,,outpatient,,,100,10,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.01,15.01,15.01,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,35.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.01,15.01,15.01,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.45,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,16.87,448,,facility
ASSAY OF SEX HORMONE GLOBUL,84270,CPT,301,RC,,,,outpatient,,,52,5.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.33,19.33,19.33,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,168.43,168.43,182.15,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,108.14,107.18,108.14,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,21.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,45.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,23.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.33,19.33,19.33,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,21.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,23.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,46.95,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,22.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,21.73,448,,facility
DRUG SCREENING FENTANYL,80354,CPT,301,RC,,,,outpatient,,,35,3.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
ASSAY OF URINE CREATININE,82570,CPT,301,RC,,,,outpatient,,,40,4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.61,4.61,4.61,213,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,71.39,41.89,142.78,14,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,37.49,23.86,74.98,60,percent of total billed charges,,,33.6,,37.49,23.85,81.31,18,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,24.07,23.86,47.71,75,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,10.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,60.5,4.61,151,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,14.91,14.91,25.41,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,85.58,85.58,85.58,1 through 10,percent of total billed charges,,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.61,4.61,4.61,636,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.18,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.18,448,,facility
COMPLEMENT/FUNCTION ACTIVITY,86161,CPT,302,RC,,,,outpatient,,,48.75,4.88,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.92,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12,448,,facility
ASSAY OF METANEPHRINES,83835,CPT,301,RC,,,,outpatient,,,111,11.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.07,15.07,15.07,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,32.45,32.45,32.45,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,35.28,35.28,35.28,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,35.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.07,15.07,15.07,11,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.61,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,16.94,448,,facility
DRUG SCREENING TAPENTADOL,80372,CPT,301,RC,,,,outpatient,,,40,4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
ASSAY OF INSULIN,83525,CPT,301,RC,,,,outpatient,,,16,1.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.17,10.17,10.17,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,20.83,20.83,20.83,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,21.02,20.83,63.84,11,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,23.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.17,10.17,10.17,12,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.69,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,11.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.43,448,,facility
DRUG ASSAY POSACONAZOLE,80187,CPT,301,RC,,,,outpatient,,,96.9,9.69,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,27.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,56.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,28.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,24.11,24.11,24.11,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,27.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,28.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,47.44,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,27.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,27.11,448,,facility
ASSAY OF LACTIC ACID,83605,CPT,301,RC,,,,outpatient,,,280.25,28.03,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.29,10.29,10.29,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,129.62,76.27,637.81,57,percent of total billed charges,,,33.6,,275.32,76.27,451.58,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,375.31,76.27,375.31,34,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,24.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,558.5,113.5,1117,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.29,10.29,10.29,439,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,23.08,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,11.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.57,448,,facility
ASSAY OF HISTAMINE,83088,CPT,301,RC,,,,outpatient,,,49.25,4.93,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,29.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,61.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,31.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,26.27,26.27,26.27,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,29.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,31.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,63.81,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,30.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,29.53,448,,facility
IMMUNOASSAY INFECTIOUS AGENT,86317,CPT,302,RC,,,,outpatient,,,36.65,3.67,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.33,13.33,13.33,86,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,59,59,59,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,52.8,26.54,52.8,41,percent of total billed charges,,,33.6,,52.8,33.6,52.8,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,33.6,33.6,33.73,52,percent of total billed charges,,,34.6,,218.53,218.53,218.53,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,31.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,50,50,50,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.33,13.33,13.33,209,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.38,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,15.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.99,448,,facility
ENZYME CELL ACTIVITY RA,82658,CPT,301,RC,,,,outpatient,,,100,10,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,44.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,44.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,45.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,44.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,92.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,46.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,44.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,46.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,77.05,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,44.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,44.03,448,,facility
TOTAL CORTISOL,82533,CPT,301,RC,,,,outpatient,,,18,1.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,14.5,14.5,14.5,28,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,68.44,68.44,68.44,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,203.28,61.25,203.28,34,percent of total billed charges,,,33.6,,203.28,129.36,203.28,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,129.36,29.57,130.52,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,34.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,192.5,58,192.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,14.5,14.5,14.5,104,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.21,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,16.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,16.3,448,,facility
DRUG SCREENING COCAINE,80353,CPT,301,RC,,,,outpatient,,,504,50.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
ASSAY OF DIBUCAINE NUMBER,82638,CPT,301,RC,,,,outpatient,,,30.8,3.08,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.46,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.25,448,,facility
OLIGOCLONAL BANDS,83916,CPT,301,RC,,,,outpatient,,,63.8,6.38,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,27.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,57.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,29.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,24.36,24.36,24.36,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,27.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,29.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,47.93,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,27.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,27.39,448,,facility
ASSAY OF NOS VITAMIN,84591,CPT,301,RC,,,,outpatient,,,85.5,8.55,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,35.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.86,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.06,448,,facility
MUMPS ANTIBODY,86735,CPT,302,RC,,,,outpatient,,,34,3.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.61,11.61,11.61,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,22.18,22.18,85.01,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,68.61,68.61,68.61,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,44,44,44,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.61,11.61,11.61,15,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.19,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.05,448,,facility
RBC OSMOTIC FRAGILITY,85557,CPT,305,RC,,,,outpatient,,,103,10.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.86,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.36,448,,facility
HEARING LOSS DUP/DEL ANALYS,81431,CPT,310,RC,,,,outpatient,,,787.5,78.75,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,679.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,679.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,699.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,679.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1420.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,720.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,679.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,720.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1189.25,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,693.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1420.3,,facility
BACTERIUM ANTIBODY,86609,CPT,302,RC,,,,outpatient,,,52.5,5.25,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,26.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.88,448,,facility
BLOOD TYPING SEROLOGIC ABO,86900,CPT,302,RC,,,,outpatient,,,12,1.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,113.1,113.1,127.33,523,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,207.68,21.24,207.68,13,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,131.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,118.27,18.88,200.99,116,percent of total billed charges,,,33.6,,118.27,18.88,118.27,44,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,118.27,12.1,134.11,78,percent of total billed charges,,,34.6,,130.24,127.78,134.11,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,266.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,134.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,176,17.88,176,13,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,73.92,7.56,73.92,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,2.66,2.66,2.66,1 through 10,percent of total billed charges,,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,2.66,2.66,2.66,824,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,134.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.46,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,129.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,6.46,448,,facility
NFCT AGT GNTYP ALYS CMV,87910,CPT,306,RC,,,,outpatient,,,800,80,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,257.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,257.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,265.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,257.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,538.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,272.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,257.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,272.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,556.22,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,262.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,257.45,556.22,,facility
ASPERGILLUS ANTIBODY,86606,CPT,302,RC,,,,outpatient,,,15.4,1.54,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,31.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.39,13.39,13.39,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.53,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,15.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,15.05,448,,facility
MITOCHONDRIAL ANTIBODY EACH,86381,CPT,302,RC,,,,outpatient,,,265,26.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,22.64,22.64,22.64,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,45.41,16.13,249.13,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,28.9,28.9,28.9,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,25.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,53.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,26.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,22.64,22.64,22.64,19,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,25.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,26.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,44.54,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,25.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,25.45,448,,facility
EPSTEIN-BARR ANTIBODY,86663,CPT,302,RC,,,,outpatient,,,17.1,1.71,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.35,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.12,448,,facility
SO/HL 51/>GSAP DNA/DNA&RNA,81455,CPT,310,RC,,,,outpatient,,,5600,560,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2919.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2919.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3007.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2919.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,6101.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3094.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2919.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3094.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5109.3,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,2977.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,6101.96,,facility
VARICELLA-ZOSTER ANTIBODY,86787,CPT,302,RC,,,,outpatient,,,42.29,4.23,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.46,11.46,11.46,39,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,82.6,23.01,82.6,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,47.54,20.59,129.19,22,percent of total billed charges,,,33.6,,47.04,47.04,266.64,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,47.04,47.04,47.54,21,percent of total billed charges,,,34.6,,221.19,221.19,221.19,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,26.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,70,70,252.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,24.36,24.36,24.36,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,11.46,11.46,11.46,1 through 10,percent of total billed charges,,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.46,11.46,11.46,200,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.88,448,,facility
TOXOPLASMA ANTIBODY,86777,CPT,302,RC,,,,outpatient,,,30,3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.8,12.8,12.8,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,64.42,64.42,64.42,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,30.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.8,12.8,12.8,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,31.1,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.39,448,,facility
HIV-1/HIV-2 1 RESULT ANTBDY,86703,CPT,302,RC,,,,outpatient,,,35,3.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,28.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.61,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.71,448,,facility
HEP B CORE ANTIBODY TOTAL,86704,CPT,302,RC,,,,outpatient,,,19,1.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.72,10.72,10.72,67,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,71.68,71.68,83.84,35,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,66.08,66.08,66.08,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,59.14,37.63,59.14,29,percent of total billed charges,,,33.6,,59.14,37.63,59.14,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,37.63,37.63,37.97,41,percent of total billed charges,,,34.6,,38.48,13.53,47.55,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,56,56,56,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.72,10.72,10.72,161,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.04,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.05,448,,facility
URINE PREGNANCY TEST,81025,CPT,307,RC,,,,outpatient,,,8,0.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,7.66,7.66,7.66,156,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,68.48,17.28,107,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,48.04,35.95,61.1,142,percent of total billed charges,,,33.6,,35.95,35.95,61.1,24,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,35.95,27.8,35.95,71,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,17.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,9.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,53.5,41,53.5,18,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,22.47,22.47,22.47,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,7.66,7.66,7.66,1310,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,9.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.07,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,8.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,8.61,448,,facility
HPYLORI STOOL AG IA,87338,CPT,306,RC,,,,outpatient,,,62.5,6.25,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.79,12.79,12.79,23,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,46.46,46.46,46.46,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,29.66,29.57,98.99,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,30.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.79,12.79,12.79,13,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,31.08,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.38,448,,facility
SMEAR GRAM STAIN,87205,CPT,306,RC,,,,outpatient,,,17.22,1.72,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.8,3.8,3.8,30,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,180.48,3.16,180.48,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,166.38,166.38,166.38,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,94.75,94.75,148.9,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,94.75,94.75,95.6,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,8.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.8,3.8,3.8,139,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.22,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,4.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,4.27,448,,facility
RUBEOLA ANTIBODY,86765,CPT,302,RC,,,,outpatient,,,18,1.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.46,11.46,11.46,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,22.18,22.18,83.95,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,20.68,20.68,20.68,1 through 10,percent of total billed charges,,,34.6,,61.35,61.35,61.35,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,26.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,44,44,44,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.46,11.46,11.46,18,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.88,448,,facility
RUSSELL VIPER VENOM DILUTED,85613,CPT,305,RC,,,,outpatient,,,64,6.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,8.52,8.52,8.52,20,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,82.37,20.06,82.37,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,52.42,52.42,52.42,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,9.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,20.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,8.52,8.52,8.52,34,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,9.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.7,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,9.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,9.58,448,,facility
HEXAGNAL PHOSPH PLTLT NEUTRL,85598,CPT,305,RC,,,,outpatient,,,103,10.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.99,15.99,15.99,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,168.32,168.32,168.32,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,37.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.98,448,,facility
BARTONELLA DNA AMP PROBE,87471,CPT,306,RC,,,,outpatient,,,266.25,26.63,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
DPYD GENE COMMON VARIANTS,81232,CPT,310,RC,,,,outpatient,,,604,60.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,174.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,174.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,180.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,174.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,365.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,185.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,174.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,185.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,305.92,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,178.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,174.81,448,,facility
NOS EACH ORGANISM AG IA,87449,CPT,306,RC,,,,outpatient,,,177,17.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,198,198,198,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,26.27,26.27,26.27,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.66,10.66,10.66,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.9,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.98,448,,facility
HEP B SURFACE ANTIBODY,86706,CPT,302,RC,,,,outpatient,,,11,1.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,33.73,33.73,33.73,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,22.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9.55,9.55,9.55,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,23.21,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,10.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,10.74,448,,facility
DETECT AGENT NOS DNA AMP,87798,CPT,306,RC,,,,outpatient,,,127.5,12.75,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,110.88,110.88,174.24,1 through 10,percent of total billed charges,,,33.6,,244.27,244.27,244.27,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,96.77,32.38,119.79,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,38.9,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
MOPATH PROCEDURE LEVEL 8,81407,CPT,310,RC,,,,outpatient,,,520,52,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,846.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,846.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,871.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,846.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1768.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,897.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,846.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,897.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1480.97,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,863.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1768.7,,facility
IMMUNFIX E-PHORSIS/URINE/CSF,86335,CPT,302,RC,,,,outpatient,,,183.75,18.38,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,26.11,26.11,26.11,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,25.76,25.76,25.76,1 through 10,percent of total billed charges,,,34.6,,56.99,56.99,56.99,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,29.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,61.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,31.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,26.11,26.11,26.11,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,29.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,31.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,63.4,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,29.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,29.35,448,,facility
LYME DIS DNA AMP PROBE,87476,CPT,306,RC,,,,outpatient,,,91.65,9.17,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
IMMUNOASSAY INFECTIOUS AGENT,86317,CPT,302,RC,,,,outpatient,,,166,16.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.33,13.33,13.33,86,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,59,59,59,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,52.8,26.54,52.8,41,percent of total billed charges,,,33.6,,52.8,33.6,52.8,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,33.6,33.6,33.73,52,percent of total billed charges,,,34.6,,218.53,218.53,218.53,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,31.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,50,50,50,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.33,13.33,13.33,209,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.38,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,15.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.99,448,,facility
HELMINTH ANTIBODY,86682,CPT,302,RC,,,,outpatient,,,240,24,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.57,11.57,11.57,36,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,56.78,56.78,66.44,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.57,11.57,11.57,12,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.11,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.01,448,,facility
ASSAY OF LIPASE,83690,CPT,301,RC,,,,outpatient,,,8.61,0.86,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,6.13,6.13,6.13,44,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,81.65,42.15,81.65,67,percent of total billed charges,,,33.6,,48.05,19.01,48.05,11,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,48.05,37.29,48.05,74,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,14.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,7.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,18,18,71.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,6.13,6.13,6.13,696,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,7.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.89,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,7.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,6.89,448,,facility
ASSAY OF PYRUVATE KINASE,84220,CPT,301,RC,,,,outpatient,,,11.8,1.18,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,9.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,19.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,8.4,8.4,8.4,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,9.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.41,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,9.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,9.44,448,,facility
DRUG ASSAY LACOSAMIDE,80235,CPT,300,RC,,,,outpatient,,,33.89,3.39,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,24.11,24.11,24.11,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,147.84,147.84,147.84,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,27.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,56.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,28.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,24.11,24.11,24.11,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,27.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,28.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,47.44,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,27.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,27.11,448,,facility
DESOXYCORTICOSTERONE,82633,CPT,301,RC,,,,outpatient,,,38.73,3.87,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,31.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,30.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,64.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,32.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,30.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,32.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,66.94,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,31.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,30.98,448,,facility
ASSAY OF GALACTOSE,82760,CPT,301,RC,,,,outpatient,,,14,1.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9.96,9.96,9.96,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,23.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9.96,9.96,9.96,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.19,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,11.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.2,448,,facility
LIPOPRO BLD ELECTROPHORETIC,83700,CPT,301,RC,,,,outpatient,,,14.08,1.41,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,23.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.33,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,11.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.26,448,,facility
ASSAY OF VITAMIN K,84597,CPT,301,RC,,,,outpatient,,,17.15,1.72,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.2,12.2,12.2,11,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,105.6,105.6,105.6,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,28.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.2,2.11,12.2,20,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.65,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.72,448,,facility
ASSAY OF LITHIUM,80178,CPT,301,RC,,,,outpatient,,,8.26,0.83,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.88,5.88,5.88,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,27.29,27.22,42.77,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,13.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,7.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.88,5.88,5.88,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,7.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.28,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,6.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,6.61,448,,facility
ANCA SCREEN EACH ANTIBODY,86036,CPT,302,RC,,,,outpatient,,,15.06,1.51,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.09,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.05,448,,facility
ASSAY OF INSULIN,83525,CPT,301,RC,,,,outpatient,,,14.29,1.43,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.17,10.17,10.17,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,20.83,20.83,20.83,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,21.02,20.83,63.84,11,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,23.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.17,10.17,10.17,12,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.69,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,11.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.43,448,,facility
DRUG ASY HYDROXYCHLOROQUINE,80220,CPT,301,RC,,,,outpatient,,,23.3,2.33,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.62,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.64,448,,facility
LONG CHAIN FATTY ACIDS,82726,CPT,301,RC,,,,outpatient,,,24.69,2.47,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,17.57,17.57,17.57,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,41.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,20.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,20.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,39.01,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,20.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,19.75,448,,facility
ASSAY FOR CALPROTECTIN FECAL,83993,CPT,301,RC,,,,outpatient,,,24.54,2.45,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,17.46,17.46,17.46,30,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,158.4,100.8,168.43,1 through 10,percent of total billed charges,,,33.6,,168.43,100.8,225.98,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,107.18,107.18,107.18,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,41.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,20.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,159.5,159.5,159.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,17.46,17.46,17.46,68,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,20.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.42,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,20.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,19.63,448,,facility
ASSAY OF CSF PROTEIN,83873,CPT,301,RC,,,,outpatient,,,21.5,2.15,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,35.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.3,15.3,15.3,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,37.17,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.2,448,,facility
DIHYDROTESTOSTERONE,82642,CPT,301,RC,,,,outpatient,,,36.6,3.66,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,22.51,22.51,22.51,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,29.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,61.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,31.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,29.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,31.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,56.93,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,29.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,29.28,448,,facility
ASSAY OF PROGESTERONE,84144,CPT,301,RC,,,,outpatient,,,26.08,2.61,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,18.55,18.55,18.55,24,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,41.3,41.3,41.3,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,36.96,23.52,222.29,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,23.52,23.52,141.46,29,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,20.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,43.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,18.55,18.55,18.55,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,20.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,45.08,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,21.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,20.86,448,,facility
ASAY OF INTERLEUKIN-6 (IL-6),83529,CPT,301,RC,,,,outpatient,,,21.59,2.16,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,36.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.22,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.27,448,,facility
CORTISOL FREE,82530,CPT,301,RC,,,,outpatient,,,20.89,2.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,211.2,211.2,211.2,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,34.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,14.86,14.86,14.86,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.1,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,16.71,448,,facility
RBC PRETREATMENT SERUM,86978,CPT,302,RC,,,,outpatient,,,72.85,7.29,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,56.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,56.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,58.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,870.14,870.14,1411.51,17,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,56.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,118,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,59.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,56.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,59.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,55.65,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,57.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,55.65,448,,facility
PLASMA FRESH FROZEN,86927,CPT,302,RC,,,,outpatient,,,203.43,20.34,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,167.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,340.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,172.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,172.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,377,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,166.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,163.06,448,,facility
AUTOMATED RBC COUNT,85041,CPT,305,RC,,,,outpatient,,,3.78,0.38,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,6.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.53,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,3.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,3.02,448,,facility
FIBRINOLYTIC PLASMINOGEN,85420,CPT,305,RC,,,,outpatient,,,8.16,0.82,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,13.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.11,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,6.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,6.53,448,,facility
HEPATITIS BE AG IA,87350,CPT,306,RC,,,,outpatient,,,14.41,1.44,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.26,10.26,10.26,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,19.14,19.14,19.14,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,12.1,12.1,12.29,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,24.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.26,10.26,10.26,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.9,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,11.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.53,448,,facility
FIBRIN DEGRADATION QUANT,85379,CPT,305,RC,,,,outpatient,,,12.73,1.27,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9.05,9.05,9.05,15,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,20.36,20.36,20.36,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,243.82,143.47,243.82,35,percent of total billed charges,,,33.6,,172.63,67.58,243.82,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,143.47,43.01,144.75,15,percent of total billed charges,,,34.6,,157.99,157.99,157.99,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,21.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,213.5,213.5,213.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,89.67,89.67,89.67,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9.05,9.05,9.05,185,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.98,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,10.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,10.18,448,,facility
COMPLETE CBC AUTOMATED,85027,CPT,305,RC,,,,outpatient,,,8.09,0.81,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.75,5.75,5.75,606,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,35.2,35.04,164.48,198,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,32.45,32.45,151.63,29,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,35.04,35.04,35.2,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,86.35,18.48,146.75,217,percent of total billed charges,,,33.6,,86.35,18.56,87.12,62,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,18.56,18.48,87.12,248,percent of total billed charges,,,34.6,,93.29,93.29,93.29,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,13.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,27.5,27.38,128.5,30,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,53.97,53.97,53.97,11,percent of total billed charges,,,35,,128.5,128.5,128.5,1 through 10,percent of total billed charges,,,40,,5.75,5.75,5.75,1 through 10,percent of total billed charges,,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.75,5.75,5.75,2267,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.97,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,6.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,6.47,448,,facility
CANDIDA ANTIBODY,86628,CPT,302,RC,,,,outpatient,,,15.01,1.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.94,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.01,448,,facility
COOMBS TEST INDIRECT TITER,86886,CPT,302,RC,,,,outpatient,,,203.43,20.34,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,150.35,150.35,150.35,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,167.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,340.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,172.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.61,4.61,4.61,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,172.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.18,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,166.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.18,448,,facility
HEPATITIS BE ANTIBODY,86707,CPT,302,RC,,,,outpatient,,,14.46,1.45,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.29,10.29,10.29,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,19.14,19.14,19.14,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,12.1,12.1,12.29,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,24.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.29,10.29,10.29,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.99,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,11.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.57,448,,facility
CULTURE TYPE IMMUNOLOGIC,87147,CPT,306,RC,,,,outpatient,,,6.48,0.65,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.61,4.61,4.61,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,69.03,69.03,69.03,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,57.55,36.95,66.81,12,percent of total billed charges,,,33.6,,39.31,39.31,39.31,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,39.31,39.31,39.31,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,10.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,58.5,58.5,58.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.61,4.61,4.61,65,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.18,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.18,448,,facility
CMV ANTIBODY IGM,86645,CPT,302,RC,,,,outpatient,,,21.06,2.11,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,14.99,14.99,14.99,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,27.52,27.52,27.52,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,163.38,163.38,163.38,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,19.83,19.82,19.83,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,35.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,14.99,0.22,14.99,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.4,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,16.85,448,,facility
BLOOD PRODUCT/IRRADIATION,86945,CPT,302,RC,,,,outpatient,,,47.76,4.78,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,74.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,55.65,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,36.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.74,448,,facility
TB TEST CELL IMMUN MEASURE,86480,CPT,302,RC,,,,outpatient,,,77.48,7.75,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,55.13,55.13,55.13,82,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,64.9,45.87,225.38,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,61.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,61.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,63.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,58.08,58.08,201.7,24,percent of total billed charges,,,33.6,,58.08,36.96,58.08,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,36.96,36.96,99.67,22,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,61.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,129.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,65.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,55,55,55,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,55.13,55.13,55.13,131,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,61.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,65.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,133.91,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,63.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,61.98,448,,facility
COMPLETE CBC W/AUTO DIFF WBC,85025,CPT,305,RC,,,,outpatient,,,9.71,0.97,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,6.91,6.91,6.91,1297,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,36.48,36.16,237.44,624,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,33.63,33.34,218.89,55,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,36.16,36.16,36.16,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,124.66,19.15,211.84,728,percent of total billed charges,,,33.6,,124.66,19.15,195.89,174,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,19.15,19.15,125.77,706,percent of total billed charges,,,34.6,,134.67,21.53,141.35,26,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,7.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,16.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,28.5,28.25,185.5,63,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,77.91,11.97,77.91,28,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,0.22,0.22,0.22,1 through 10,percent of total billed charges,,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,6.91,6.91,6.91,5659,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,7.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.78,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,7.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,7.77,448,,facility
HIV-1ANTIBODY,86701,CPT,302,RC,,,,outpatient,,,11.11,1.11,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,7.91,7.91,7.91,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,66.56,66.56,108.8,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,63.13,63.13,63.13,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,34.94,34.94,54.91,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,34.29,34.29,37.75,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,18.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,9.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,7.91,7.91,7.91,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,9.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.2,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,9.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,8.89,448,,facility
SPECIMEN INFECT AGNT CONCNTJ,87015,CPT,306,RC,,,,outpatient,,,8.35,0.84,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.94,5.94,5.94,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,13.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,7.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.94,5.94,5.94,23,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,7.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.42,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,6.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,6.68,448,,facility
EPSTEIN-BARR NUCLEAR ANTIGEN,86664,CPT,302,RC,,,,outpatient,,,19.11,1.91,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.6,13.6,13.6,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,49.92,22.4,49.92,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,41.18,41.18,41.18,1 through 10,percent of total billed charges,,,33.6,,71.57,71.57,71.57,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,28.56,28.56,71.57,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,31.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.6,13.6,13.6,15,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,33.04,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,15.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,15.29,448,,facility
X-RAY EXAM L-2 SPINE 4/>VWS,72110,CPT,320,RC,,,,outpatient,,,130.94,13.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,882.56,882.56,882.56,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,728.11,728.11,728.11,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,467.48,467.48,467.48,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,448,,facility
MECP2 GENE DUP/DELET VARIANT,81304,CPT,310,RC,,,,outpatient,,,187.5,18.75,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,150,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,150,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,154.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,150,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,313.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,159,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,150,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,159,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,262.5,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,153,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,150,448,,facility
INSITU HYBRIDIZATION (FISH),88365,CPT,310,RC,,,,outpatient,,,203.43,20.34,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,163,163,163,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,167.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,169.34,169.34,266.11,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,340.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,172.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,252,252,252,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,107.35,107.35,339.75,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,172.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,226.07,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,166.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,163.06,448,,facility
X-RAY EXAM ENTIRE SPI 1 VW,72081,CPT,320,RC,,,,outpatient,,,108.23,10.82,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,540.16,540.16,540.16,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,85.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,283.58,283.58,445.63,1 through 10,percent of total billed charges,,,33.6,,283.58,283.58,283.58,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,174.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,84.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,83.29,448,,facility
URINALYSIS AUTO W/O SCOPE,81003,CPT,307,RC,,,,outpatient,,,2.81,0.28,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,2,2,2,141,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,148.09,148.09,148.09,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,143.32,15.84,143.32,137,percent of total billed charges,,,33.6,,84.34,9.5,143.32,35,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,84.34,10.08,85.09,61,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,4.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,125.5,125.5,125.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,251,251,251,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,2,2,2,1 through 10,percent of total billed charges,,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,2,2,2,997,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.85,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,2.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,2.25,448,,facility
JAK2 GENE TRGT SEQUENCE ALYS,81279,CPT,310,RC,,,,outpatient,,,231.5,23.15,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,185.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,185.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,190.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,185.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,387.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,196.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,164.73,164.73,164.73,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,185.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,196.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,324.1,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,188.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,185.2,448,,facility
DMPK GENE DETC ABNOR ALLELE,81234,CPT,310,RC,,,,outpatient,,,171.25,17.13,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,121.86,121.86,121.86,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,137,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,137,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,141.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,137,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,286.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,145.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,137,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,145.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,239.75,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,139.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,137,448,,facility
KRAS GENE ADDL VARIANTS,81276,CPT,310,RC,,,,outpatient,,,241.56,24.16,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,193.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,193.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,199.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,193.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,403.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,204.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,193.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,204.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,338.19,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,197.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,193.25,448,,facility
X-RAY EXAM ENTIRE SPI 2/3 VW,72082,CPT,320,RC,,,,outpatient,,,130.94,13.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,448,,facility
TUMOR IMMUNOHISTOCHEM/MANUAL,88360,CPT,310,RC,,,,outpatient,,,203.43,20.34,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,150.35,150.35,163.06,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,82.41,82.41,329.64,11,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,167.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,159.24,53.08,234.83,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,106.16,48.38,351.46,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,340.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,172.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,261.5,261.5,261.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,60.48,60.48,109.83,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,63.93,63.93,66.9,16,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,172.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,377,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,166.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,163.06,448,,facility
CHROMOSOME ANALYS PLACENTA,88267,CPT,311,RC,,,,outpatient,,,235.71,23.57,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,188.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,188.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,194.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,188.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,394.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,199.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,188.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,199.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,388.41,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,192.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,188.57,448,,facility
HBA1/HBA2 GENE FAM VRNT,81258,CPT,310,RC,,,,outpatient,,,469.06,46.91,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,375.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,375.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,386.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,375.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,784.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,397.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,375.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,397.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,656.69,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,382.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,375.25,784.27,,facility
X-RAY EXAM NECK SPINE 2-3 VW,72040,CPT,320,RC,,,,outpatient,,,108.23,10.82,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,604.16,604.16,604.16,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,85.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,498.43,317.18,539.02,19,percent of total billed charges,,,33.6,,317.18,317.18,317.18,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,317.18,317.18,320.02,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,174.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,472,472,472,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,23.45,23.45,24.14,39,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,84.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,83.29,448,,facility
X-RAY EXAM OF NECK,70360,CPT,320,RC,,,,outpatient,,,108.23,10.82,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,85.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,174.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,18.33,18.33,18.86,12,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,84.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,83.29,448,,facility
THERAPEUTIC PROCD STRG ENDUR,G0237,HCPCS,410,RC,,,,inpatient,,,35.46,3.55,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Short Stay Lesser of + Days Threshold 1.00 + Stoploss First Dollar + Reimbursement Rate 57.00 + Basic Per Diem + Fixed Rate 5000.00 + Fixed Amount 157464.00,,,,0,other,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,Short Stay Lesser of + Days Threshold 1.00 + Stoploss First Dollar + Reimbursement Rate 72.00 + Basic Per Diem + Fixed Rate 10000.00 + Fixed Amount 56687.00,,,,0,other,NTE Percentage + Reimbursement Rate 85.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,47.3,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,facility
TP53 GENE KNOWN FAMIL VRNT,81353,CPT,310,RC,,,,outpatient,,,385,38.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,308,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,308,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,317.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,308,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,643.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,326.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,308,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,326.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,539,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,314.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,308,643.72,,facility
X-RAY EXAM OF SINUSES,70220,CPT,320,RC,,,,outpatient,,,108.23,10.82,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,85.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,174.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,84.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,83.29,448,,facility
IDH1 COMMON VARIANTS,81120,CPT,310,RC,,,,outpatient,,,241.56,24.16,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,193.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,193.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,199.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,89.16,89.16,89.16,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,193.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,403.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,204.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,193.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,204.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,338.19,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,197.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,193.25,448,,facility
X-RAY EXAM CHEST 1 VIEW,71045,CPT,324,RC,,,,outpatient,,,108.23,10.82,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,77.25,76.83,83.29,557,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,385.28,83.28,411,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,85.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,343.74,202.27,343.74,71,percent of total billed charges,,,33.6,,343.74,202.27,343.74,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,202.27,202.27,204.08,31,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,174.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,301,301,301,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,14.01,14.01,14.42,472,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,84.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,83.29,448,,facility
FLT3 GENE ANALYSIS,81246,CPT,310,RC,,,,outpatient,,,103.75,10.38,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,85.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,173.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,87.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,87.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,145.25,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,84.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,83,448,,facility
X-RAY EXAM OF PELVIS,72190,CPT,320,RC,,,,outpatient,,,130.94,13.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,677.76,677.76,677.76,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,559.15,559.15,559.15,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,355.82,355.82,359,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,448,,facility
X-RAY EXAM THORAC SPINE 3VWS,72072,CPT,320,RC,,,,outpatient,,,130.94,13.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,773.76,773.76,773.76,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,406.22,406.22,406.22,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,23.18,23.18,24.14,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,448,,facility
HEXA GENE,81255,CPT,310,RC,,,,outpatient,,,64.31,6.43,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,51.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,51.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,52.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,51.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,107.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,54.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,51.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,54.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,90.04,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,52.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,51.45,448,,facility
FETAL CHRMOML MICRODELTJ,81422,CPT,310,RC,,,,outpatient,,,948.81,94.88,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,759.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,759.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,781.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,759.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1586.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,804.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,759.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,804.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1328.34,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,774.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1586.41,,facility
IMG GID FLU COLL DRG SFT TIS,10030,CPT,361,RC,,,,outpatient,,,837.95,83.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,617.33,617.33,617.33,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,677.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,677.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,698.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,677.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1416.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,718.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,677.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,718.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2712,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,691.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,2712,,facility
LYSE CHEST FIBRIN INIT DAY,32561,CPT,361,RC,,,,outpatient,,,748.19,74.82,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,600.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,600.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,618.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,600.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1254.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,636.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,600.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,636.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2712,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,612.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,2712,,facility
CT UPPR EXTREMITY W/O&W/DYE,73202,CPT,352,RC,,,,outpatient,,,218.83,21.88,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,403,,,,,,,case rate,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,371,,,,,,,case rate,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,875,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1050,,,,,,,case rate,NTE Percentage + Reimbursement Rate 85.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,172.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,350.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,177.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,177.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1522,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,171.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,167.87,1522,,facility
TX TARSAL B1 FX W/MNPJ EACH,28455,CPT,450,RC,,,,outpatient,,,1914.16,191.42,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1585.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3216.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1631.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1631.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1569.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3216.38,,facility
REPLACE G-J TUBE PERC,49452,CPT,361,RC,,,,outpatient,,,1079.61,107.96,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,868.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,868.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,894.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,868.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1814.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,920.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,868.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,920.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3821,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,885.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3821,,facility
PLMT ACCESS BIL TREE SM BWL,47541,CPT,361,RC,,,,outpatient,,,9010.51,901.05,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,6195.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6195.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6381.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6195.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,12949.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6567.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6195.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6567.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10137,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,6319.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,12949.24,,facility
CLSD TX NSL FX MNPJ WO STBLJ,21315,CPT,450,RC,,,,outpatient,,,1816.31,181.63,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1484.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1484.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1529.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1484.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3103.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1574.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1484.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1574.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1514.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3103.57,,facility
CLTX RDL HEAD/NCK FX WO MNPJ,24650,CPT,450,RC,,,,outpatient,,,280.86,28.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,243.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,493.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,240.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,236.08,1173,,facility
"PLATELETS, HLA-M, L/R, UNIT",P9052,HCPCS,390,RC,,,,outpatient,,,900.84,90.08,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,704.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,704.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,725.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,704.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1472.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,746.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,704.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,746.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,107,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,718.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,107,1472.59,,facility
REMOVAL FOREIGN BODY GUM,41805,CPT,450,RC,,,,outpatient,,,1816.31,181.63,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1484.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1484.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1529.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1484.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3103.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1574.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1484.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1574.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1514.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3103.57,,facility
RMVL FB UPPER ARM/ELBW SUBQ,24200,CPT,450,RC,,,,outpatient,,,1930.94,193.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1628.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3303.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1675.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1675.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1612.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3303.62,,facility
"PLASMA PROTEIN FRACT,5%,50ML",P9043,HCPCS,390,RC,,,,outpatient,,,9.94,0.99,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,16.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,107,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,8.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,8.07,448,,facility
CORE NDL BX LNG/MED PERQ,32408,CPT,361,RC,,,,outpatient,,,1930.94,193.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1628.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3303.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1675.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1675.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3821,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1612.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3821,,facility
US EXAM ABDO BACK WALL LIM,76775,CPT,402,RC,,,,outpatient,,,130.94,13.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,27.19,27.19,27.19,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,465,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,465,,facility
DBRDMT BONE 1ST 20 SQ CM/<,11044,CPT,361,RC,,,,outpatient,,,1930.94,193.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1628.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3303.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1675.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1675.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2712,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1612.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3303.62,,facility
INS CATH REN ART 1ST BILAT,36252,CPT,361,RC,,,,outpatient,,,3796.26,379.63,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,3021.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3021.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3112.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3021.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,6315.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3203.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3021.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3203.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10137,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,3082.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,10137,,facility
EGD REMOVE FOREIGN BODY,43247,CPT,450,RC,,,,outpatient,,,1079.61,107.96,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,868.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,868.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,894.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,868.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1814.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,920.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,868.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,920.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,885.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1814.2,,facility
"DARBEPOETIN ALFA, NON-ESRD",J0881,HCPCS,636,RC,,,,outpatient,,,3.83,0.38,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,2.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,6.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.39,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,2.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,2.92,448,,facility
DSTRJ MAL LES T/A/L 0.5 CM/<,17260,CPT,761,RC,,,,outpatient,,,238.44,23.84,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,197.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,401.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,203.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,203.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,195.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,192.01,1173,,facility
SHAVE SKIN LESION >2.0 CM,11303,CPT,761,RC,,,,outpatient,,,474.9,47.49,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,400.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,813.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,412.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,412.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,396.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,389.05,813.11,,facility
EXC FACE-MM B9+MARG 1.1-2 CM,11442,CPT,761,RC,,,,outpatient,,,837.95,83.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,677.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,677.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,698.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,677.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1416.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,718.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,626.56,626.56,626.56,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,677.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,718.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,691.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1416.43,,facility
"INJ., DURVALUMAB, 10 MG",J9173,HCPCS,636,RC,,,,outpatient,,,102.34,10.23,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,87.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,87.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,90.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,87.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,183.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,93.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,87.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,93.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,180.34,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,89.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,87.95,448,,facility
DSTR CUT VSC PRLF LES10-50SQ,17107,CPT,761,RC,,,,outpatient,,,748,74.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,707.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,707.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,728.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,707.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1478.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,749.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,707.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,749.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,721.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1478.34,,facility
EXC TR-EXT B9+MARG 0.5 CM<,11400,CPT,761,RC,,,,outpatient,,,837.95,83.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,677.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,677.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,698.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,677.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1416.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,718.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,677.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,718.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,691.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1416.43,,facility
DESTRUCTION PENIS LESION(S),54065,CPT,761,RC,,,,outpatient,,,2171.91,217.19,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1974.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1974.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2033.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1974.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,4127.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2093.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1974.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2093.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,2014.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,4127.08,,facility
DESTRUCTION B9 LES UP TO 14,17110,CPT,761,RC,,,,outpatient,,,238.44,23.84,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,174.34,163.22,177.11,16,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,197.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,401.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,203.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,176.95,176.95,180.67,96,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,203.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,402.43,402.43,402.43,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,195.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,192.01,1173,,facility
RESPIRATORY FLOW VOLUME LOOP,94375,CPT,460,RC,,,,outpatient,,,373.83,37.38,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,206.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,206.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,212.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,206.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,431.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,219.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,20.21,20.21,20.8,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,206.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,219.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,611,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,210.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,206.65,611,,facility
MICROVOLT T-WAVE ASSESS,93025,CPT,480,RC,,,,outpatient,,,186.04,18.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,123.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,123.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,126.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,123.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,257.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,130.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,123.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,130.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1463,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,125.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,123.14,1463,,facility
FECAL MICROBIOTA PREP INSTIL,G0455,HCPCS,750,RC,,,,outpatient,,,1088.51,108.85,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,890.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,890.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,916.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,890.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1860.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,943.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,890.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,943.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,907.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1860.16,,facility
TREAT METACARPAL FRACTURE,26600,CPT,761,RC,,,,outpatient,,,280.86,28.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,243.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,493.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,240.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,236.08,493.41,,facility
EXC TR-EXT MAL+MARG >4 CM,11606,CPT,761,RC,,,,outpatient,,,1930.94,193.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,1421.6,1421.6,1487.27,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1628.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3303.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1675.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1675.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,1612.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3303.62,,facility
INJ PEGFILGRASTIM-BMEZ 0.5MG,Q5120,HCPCS,636,RC,,,,outpatient,,,433.44,43.34,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,132.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,132.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,136.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,132.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,276.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,140.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,132.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,140.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,53.13,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,134.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,53.13,448,,facility
RPR S/N/AX/GEN/TRNK >30.0 CM,12007,CPT,761,RC,,,,outpatient,,,238.44,23.84,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,197.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,401.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,203.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,203.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,195.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,192.01,1311,,facility
INJ HERZUMA 10 MG,Q5113,HCPCS,636,RC,,,,outpatient,,,78.29,7.83,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,54.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,54.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,56.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,54.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,114.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,58.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,54.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,58.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,154.76,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,56.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,54.94,448,,facility
DECLOT VASCULAR DEVICE,36593,CPT,510,RC,,,,outpatient,,,403.35,40.34,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,316.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,316.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,325.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,316.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,660.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,335.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,316.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,335.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,322.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,316.12,1173,,facility
SHAVE SKIN LESION 0.6-1.0 CM,11306,CPT,761,RC,,,,outpatient,,,238.44,23.84,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,197.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,401.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,203.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,203.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,195.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,192.01,448,,facility
ACTIGRAPHY TESTING,95803,CPT,740,RC,,,,outpatient,,,72.85,7.29,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,56.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,56.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,58.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,56.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,118,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,59.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,56.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,59.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1175,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,57.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,56.46,1175,,facility
DESTROY INTERNAL HEMORRHOIDS,46930,CPT,750,RC,,,,outpatient,,,1405.45,140.55,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1179.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,2393.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1213.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1213.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2712,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1168.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,2712,,facility
CLTX SHO DSLC W/MNPJ WO ANES,23650,CPT,761,RC,,,,outpatient,,,280.86,28.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,243.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,493.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,240.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,236.08,1173,,facility
INITIAL PREVENTIVE EXAM,G0402,HCPCS,770,RC,,,,outpatient,,,157.44,15.74,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,127.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,127.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,131.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,127.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,266.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,135.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,127.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,135.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,129.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,127.42,448,,facility
PSYTX W PT 30 MINUTES,90832,CPT,914,RC,,,,outpatient,,,189.89,18.99,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,140.97,140.97,152.83,43,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,169.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,169.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,174.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,169.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,355.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,180.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,169.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,180.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,173.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,169.87,448,,professional
DESTRUCTION PENIS LESION(S),54055,CPT,761,RC,,,,outpatient,,,2171.91,217.19,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1974.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1974.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2033.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1974.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,4127.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2093.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1974.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2093.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,2014.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,4127.08,,facility
NVR CNDJ TST 1-2 STUDIES,95907,CPT,922,RC,,,,outpatient,,,186.04,18.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,206.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,206.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,212.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,206.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,431.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,219.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,206.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,219.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,478,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,210.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,206.65,478,,facility
CONT GLUC MNTR PHYS/QHP EQP,95250,CPT,920,RC,,,,outpatient,,,157.44,15.74,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,127.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,127.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,131.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,127.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,266.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,135.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,127.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,135.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,422,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,129.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,127.42,448,,facility
PHENYTOIN LEVEL; TOTAL,80185,CPT,0301,RC,,,,outpatient,,,133,13.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,70.22,70.22,70.22,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,44.69,44.69,44.69,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.79,11.79,11.79,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.63,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.25,448,,facility
DRUG TEST PRSMV CHEM ANLYZR,80307,CPT,301,RC,,,,outpatient,,,520,52,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,55.27,55.27,55.27,34,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,62.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,62.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,171.87,131.38,223.26,14,percent of total billed charges,,,33.6,,206.45,131.38,223.26,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,131.38,102.04,131.38,13,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,62.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,129.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,65.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,55.27,55.27,55.27,332,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,62.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,65.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,125.7,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,63.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,62.14,448,,facility
ASSAY OF TACROLIMUS,80197,CPT,301,RC,,,,outpatient,,,443,44.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.21,12.21,12.21,100,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,71.44,70.9,318.86,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,361.57,70.9,361.57,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,28.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.21,12.21,12.21,313,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.68,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.73,448,,facility
HEMOGLOBIN ELECTROPHORESIS,83020,CPT,301,RC,,,,outpatient,,,422,42.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.45,11.45,11.45,22,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,12.1,12.1,12.29,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,26.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,18,18,18,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,29.19,29.19,29.19,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.45,11.45,11.45,47,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,12.87,12.87,12.87,1 through 10,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.81,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,13.13,13.13,13.13,1 through 10,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,12.87,448,,facility
QUANTITATIVE ASSAY DRUG,80299,CPT,301,RC,,,,outpatient,,,126,12.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,13,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,174.64,174.64,174.64,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,171.6,171.6,171.6,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,374.52,374.52,374.52,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.62,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.64,448,,facility
SYMES TYPE PTB BRIM DESIGN S,L5632,HCPCS,274,RC,,,,outpatient,,,405,40.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,66,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,61,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,271.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,271.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,279.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,271.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,568.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,288.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,271.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,288.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,277.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,271.83,568.12,,facility
QUANTITATIVE ASSAY DRUG,80299,CPT,301,RC,,,,outpatient,,,142,14.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,13,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,174.64,174.64,174.64,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,171.6,171.6,171.6,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,374.52,374.52,374.52,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.62,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.64,448,,facility
AMINO ACIDS SINGLE QUANT,82131,CPT,301,RC,,,,outpatient,,,493,49.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,23.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,48.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,24.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,24.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,40.22,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,23.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,22.98,448,,facility
ALPHA-FETOPROTEIN SERUM,82105,CPT,301,RC,,,,outpatient,,,365,36.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,14.92,14.92,14.92,44,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,215.35,215.35,215.35,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,58.61,58.61,192.72,11,percent of total billed charges,,,33.6,,58.61,37.3,122.64,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,37.3,37.3,123.74,15,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,35.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,14.92,14.92,14.92,104,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.24,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,16.77,448,,facility
PNEUMA/VAC WALK BOOT PRE OTS,L4361,HCPCS,274,RC,,,,outpatient,,,498,49.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,175.85,175.85,351.7,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,66,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,61,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,318.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,318.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,327.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,298.79,298.79,328.44,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,318.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,665,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,337.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,318.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,337.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,386.8,386.8,386.8,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,324.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,318.18,665,,facility
ASSAY OF ALDOSTERONE,82088,CPT,301,RC,,,,outpatient,,,85,8.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,36.25,36.25,36.25,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,32.45,32.45,63.72,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,40.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,40.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,41.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,29.04,18.48,29.04,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,18.48,17.81,46.37,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,40.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,85.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,43.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,36.25,36.25,36.25,24,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,40.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,43.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,88.04,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,41.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,40.75,448,,facility
GROWTH HORMONE PANEL,80430,CPT,301,RC,,,,outpatient,,,201,20.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,129.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,129.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,133.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,129.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,270.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,137.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,129.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,137.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,226.33,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,131.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,129.33,448,,facility
QUANTITATIVE ASSAY DRUG,80299,CPT,301,RC,,,,outpatient,,,170,17,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,13,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,174.64,174.64,174.64,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,171.6,171.6,171.6,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,374.52,374.52,374.52,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.62,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.64,448,,facility
INFUSION INTO A VEIN FOR HYDRATION; 31-60 MINUTES,96360,CPT,0260,RC,,,,outpatient,,,569,56.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,184.86,173.06,191.54,106,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,442.88,442.88,442.88,12,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,203.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,203.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,209.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,365.38,232.51,365.38,23,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,232.51,232.51,232.51,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,203.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,425.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,215.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,346,346,346,20,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,187.62,187.62,191.54,94,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,203.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,215.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,427,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,207.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,203.57,448,,facility
DRUG TEST PRSMV CHEM ANLYZR,80307,CPT,301,RC,,,,outpatient,,,203,20.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,55.27,55.27,55.27,34,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,62.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,62.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,171.87,131.38,223.26,14,percent of total billed charges,,,33.6,,206.45,131.38,223.26,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,131.38,102.04,131.38,13,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,62.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,129.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,65.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,55.27,55.27,55.27,332,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,62.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,65.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,125.7,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,63.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,62.14,448,,facility
DRUG/SUBSTANCE NOS 1-3,80375,CPT,301,RC,,,,outpatient,,,262,26.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
ESTRIOL (HORMONE) LEVEL,82677,CPT,0301,RC,,,,outpatient,,,22.5,2.25,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,21.51,21.51,21.51,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,7.73,7.73,7.73,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,24.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,50.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,25.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,21.51,21.51,51.51,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,24.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,25.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,52.24,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,24.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,24.18,448,,facility
TOTAL CORTISOL,82533,CPT,301,RC,,,,outpatient,,,116,11.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,14.5,14.5,14.5,28,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,68.44,68.44,68.44,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,203.28,61.25,203.28,34,percent of total billed charges,,,33.6,,203.28,129.36,203.28,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,129.36,29.57,130.52,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,34.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,192.5,58,192.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,14.5,14.5,14.5,104,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.21,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,16.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,16.3,448,,facility
CHEMILUMINESCENT ASSAY,82397,CPT,301,RC,,,,outpatient,,,456,45.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.56,12.56,12.56,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,22.85,22.85,22.85,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,29.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.56,12.56,12.56,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.5,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.12,448,,facility
IMMUNOASSAY NONANTIBODY,83516,CPT,301,RC,,,,outpatient,,,806,80.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9,9,10.26,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,4.75,4.75,218.59,30,percent of total billed charges,,,33.6,,3.02,3.02,175.39,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,3.02,3.02,211.68,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,24.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,23.5,23.5,23.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9,9,10.26,51,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.92,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,11.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.53,448,,facility
IMMUNOASSAY NONANTIBODY,83516,CPT,301,RC,,,,outpatient,,,207,20.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9,9,10.26,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,4.75,4.75,218.59,30,percent of total billed charges,,,33.6,,3.02,3.02,175.39,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,3.02,3.02,211.68,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,24.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,23.5,23.5,23.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9,9,10.26,51,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.92,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,11.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.53,448,,facility
ASSAY OF URINE CREATININE,82570,CPT,301,RC,,,,outpatient,,,21,2.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.61,4.61,4.61,213,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,71.39,41.89,142.78,14,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,37.49,23.86,74.98,60,percent of total billed charges,,,33.6,,37.49,23.85,81.31,18,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,24.07,23.86,47.71,75,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,10.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,60.5,4.61,151,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,14.91,14.91,25.41,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,85.58,85.58,85.58,1 through 10,percent of total billed charges,,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.61,4.61,4.61,636,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.18,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.18,448,,facility
IMMUNOASSAY QUANT NOS NONAB,83520,CPT,301,RC,,,,outpatient,,,562,56.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,36,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,66.08,66.08,66.08,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,41.18,24.82,318.38,1 through 10,percent of total billed charges,,,33.6,,37.63,37.63,96.43,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,33.6,23.18,176.4,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,36.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,87,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.22,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.27,448,,facility
HEMOGLOBIN CHROMOTOGRAPHY,83021,CPT,301,RC,,,,outpatient,,,771,77.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.06,16.06,16.06,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,37.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,58.38,58.38,58.38,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.06,16.06,16.06,16,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,39.01,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.06,448,,facility
IMMUNOASSAY QUANT NOS NONAB,83520,CPT,301,RC,,,,outpatient,,,208,20.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,36,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,66.08,66.08,66.08,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,41.18,24.82,318.38,1 through 10,percent of total billed charges,,,33.6,,37.63,37.63,96.43,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,33.6,23.18,176.4,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,36.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,87,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.22,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.27,448,,facility
ASSAY OF MAGNESIUM,83735,CPT,301,RC,,,,outpatient,,,221,22.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.96,5.96,5.96,292,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,9.38,5.96,25.37,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,197.47,22.7,213.55,144,percent of total billed charges,,,33.6,,125.66,125.66,126.79,59,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,125.66,14.45,142.49,154,percent of total billed charges,,,34.6,,135.76,135.76,142.49,1 through 10,percent of total billed charges,,,45,,5.96,5.96,5.96,1 through 10,percent of total billed charges,,6.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,7.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,21.5,21.5,187,13,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,78.54,78.54,78.54,21,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.96,5.96,5.96,1555,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,7.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.47,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,6.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,6.7,448,,facility
IMMUNOASSAY QUANT NOS NONAB,83520,CPT,301,RC,,,,outpatient,,,412,41.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,36,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,66.08,66.08,66.08,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,41.18,24.82,318.38,1 through 10,percent of total billed charges,,,33.6,,37.63,37.63,96.43,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,33.6,23.18,176.4,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,36.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,87,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.22,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.27,448,,facility
IMMUNOASSAY NONANTIBODY,83516,CPT,301,RC,,,,outpatient,,,63,6.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9,9,10.26,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,4.75,4.75,218.59,30,percent of total billed charges,,,33.6,,3.02,3.02,175.39,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,3.02,3.02,211.68,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,24.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,23.5,23.5,23.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9,9,10.26,51,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.92,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,11.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.53,448,,facility
LIPOPROTEIN LEVEL; QUANTITATION OF LIPOPROTEIN PARTICLE NUMBER(S),83704,CPT,0301,RC,,,,outpatient,,,55,5.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,34.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,34.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,34.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,71.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,36.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,34.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,36.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,68.16,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,34.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,34.19,448,,facility
IMMUNOASSAY NONANTIBODY,83516,CPT,301,RC,,,,outpatient,,,670,67,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9,9,10.26,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,4.75,4.75,218.59,30,percent of total billed charges,,,33.6,,3.02,3.02,175.39,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,3.02,3.02,211.68,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,24.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,23.5,23.5,23.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9,9,10.26,51,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.92,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,11.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.53,448,,facility
MASS SPECTROMETRY QUAL/QUAN,83789,CPT,301,RC,,,,outpatient,,,440,44,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,24.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,50.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,25.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,24.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,25.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.19,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,24.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,24.11,448,,facility
ENZYME CELL ACTIVITY,82657,CPT,301,RC,,,,outpatient,,,600,60,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.72,19.72,19.72,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,2094.14,2094.14,2094.14,1 through 10,percent of total billed charges,,,33.6,,762.96,762.96,762.96,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,46.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,23.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.72,19.72,19.72,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,23.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,39.01,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,22.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,22.17,448,,facility
IMMUNOASSAY QUANT NOS NONAB,83520,CPT,301,RC,,,,outpatient,,,1699,169.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,36,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,66.08,66.08,66.08,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,41.18,24.82,318.38,1 through 10,percent of total billed charges,,,33.6,,37.63,37.63,96.43,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,33.6,23.18,176.4,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,36.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,87,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.22,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.27,448,,facility
COPPER LEVEL,82525,CPT,0301,RC,,,,outpatient,,,240,24,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.04,11.04,11.04,18,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,35.64,22.85,35.9,1 through 10,percent of total billed charges,,,33.6,,80.64,80.64,80.64,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,22.85,19.49,22.85,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,50.4,50.4,50.4,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.04,11.04,11.04,37,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.81,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.41,448,,facility
ENZYME CELL ACTIVITY,82657,CPT,301,RC,,,,outpatient,,,1409,140.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.72,19.72,19.72,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,2094.14,2094.14,2094.14,1 through 10,percent of total billed charges,,,33.6,,762.96,762.96,762.96,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,46.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,23.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.72,19.72,19.72,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,23.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,39.01,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,22.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,22.17,448,,facility
ASSAY OF URINE CREATININE,82570,CPT,301,RC,,,,outpatient,,,31,3.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.61,4.61,4.61,213,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,71.39,41.89,142.78,14,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,37.49,23.86,74.98,60,percent of total billed charges,,,33.6,,37.49,23.85,81.31,18,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,24.07,23.86,47.71,75,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,10.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,60.5,4.61,151,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,14.91,14.91,25.41,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,85.58,85.58,85.58,1 through 10,percent of total billed charges,,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.61,4.61,4.61,636,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.18,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.18,448,,facility
ASSAY OF BLOOD OSMOLALITY,83930,CPT,301,RC,,,,outpatient,,,254,25.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.88,5.88,5.88,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,16.13,16.13,85.34,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,13.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,7.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,24,24,24,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.88,5.88,5.88,11,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,7.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.28,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,6.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,6.61,448,,facility
GONADOTROPIN; FOLLICLE STIMULATING (REPRODUCTIVE HORMONE) LEVEL,83001,CPT,0301,RC,,,,outpatient,,,67,6.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.53,16.53,16.53,63,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,146.91,146.91,146.91,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,35.38,22.51,35.38,22,percent of total billed charges,,,33.6,,35.38,35.38,131.47,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,22.51,22.51,83.66,27,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,33.5,33.5,33.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,14.07,14.07,14.07,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.53,16.53,16.53,116,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,40.15,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.58,448,,facility
ASSAY OF URINE CREATININE,82570,CPT,301,RC,,,,outpatient,,,121,12.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.61,4.61,4.61,213,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,71.39,41.89,142.78,14,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,37.49,23.86,74.98,60,percent of total billed charges,,,33.6,,37.49,23.85,81.31,18,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,24.07,23.86,47.71,75,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,10.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,60.5,4.61,151,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,14.91,14.91,25.41,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,85.58,85.58,85.58,1 through 10,percent of total billed charges,,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.61,4.61,4.61,636,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.18,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.18,448,,facility
IMMUNOASSAY QUANT NOS NONAB,83520,CPT,301,RC,,,,outpatient,,,1448,144.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,36,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,66.08,66.08,66.08,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,41.18,24.82,318.38,1 through 10,percent of total billed charges,,,33.6,,37.63,37.63,96.43,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,33.6,23.18,176.4,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,36.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,87,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.22,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.27,448,,facility
CORTISOL (HORMONE) MEASUREMENT; TOTAL,82533,CPT,0301,RC,,,,outpatient,,,385,38.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,14.5,14.5,14.5,28,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,68.44,68.44,68.44,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,203.28,61.25,203.28,34,percent of total billed charges,,,33.6,,203.28,129.36,203.28,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,129.36,29.57,130.52,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,34.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,192.5,58,192.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,14.5,14.5,14.5,104,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.21,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,16.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,16.3,448,,facility
FLUORESCENT ANTIBODY SCREEN,86255,CPT,302,RC,,,,outpatient,,,435,43.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.72,10.72,10.72,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,45.41,28.9,1068.67,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,28.9,28.9,28.9,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.72,10.72,10.72,19,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.04,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.05,448,,facility
ASSAY OF THYROID (T3 OR T4),84479,CPT,301,RC,,,,outpatient,,,30,3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.75,5.75,5.75,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,70.56,27.98,119.91,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,17.97,17.81,70.56,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,13.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.75,5.75,5.75,23,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.97,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,6.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,6.47,448,,facility
FLUORESCENT ANTIBODY SCREEN,86255,CPT,302,RC,,,,outpatient,,,791,79.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.72,10.72,10.72,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,45.41,28.9,1068.67,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,28.9,28.9,28.9,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.72,10.72,10.72,19,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.04,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.05,448,,facility
NUCLEAR ANTIGEN ANTIBODY,86235,CPT,302,RC,,,,outpatient,,,327,32.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13,12.5,15.95,11,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,54.91,4.37,90.29,43,percent of total billed charges,,,33.6,,4.37,4.37,53.09,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,22.18,4.24,83.33,13,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,37.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.95,13,15.95,54,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.75,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.93,448,,facility
COMPLEMENT ANTIGEN,86160,CPT,302,RC,,,,outpatient,,,265,26.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.67,10.67,10.67,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,87.32,87.32,87.32,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,78.14,49.73,270.86,17,percent of total billed charges,,,33.6,,49.73,49.73,172.37,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,49.73,29.23,50.32,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,256.5,256.5,256.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.67,10.67,10.67,61,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.92,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12,448,,facility
PROTEIN WESTERN BLOT TEST,84182,CPT,301,RC,,,,outpatient,,,651,65.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,217.54,217.54,217.54,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,29.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,61.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,30.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,25.98,25.98,25.98,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,29.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,30.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,51.12,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,29.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,29.21,448,,facility
LYME DISEASE ANTIBODY,86618,CPT,302,RC,,,,outpatient,,,550,55,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,35.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.15,15.15,15.15,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.79,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.03,448,,facility
MITOCHONDRIAL ANTIBODY EACH,86381,CPT,302,RC,,,,outpatient,,,337,33.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,22.64,22.64,22.64,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,45.41,16.13,249.13,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,28.9,28.9,28.9,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,25.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,53.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,26.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,22.64,22.64,22.64,19,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,25.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,26.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,44.54,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,25.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,25.45,448,,facility
NUCLEAR ANTIGEN ANTIBODY,86235,CPT,302,RC,,,,outpatient,,,323,32.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13,12.5,15.95,11,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,54.91,4.37,90.29,43,percent of total billed charges,,,33.6,,4.37,4.37,53.09,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,22.18,4.24,83.33,13,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,37.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.95,13,15.95,54,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.75,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.93,448,,facility
BLASTOMYCES ANTIBODY,86612,CPT,302,RC,,,,outpatient,,,45,4.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,26.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.88,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.9,448,,facility
B CELLS TOTAL COUNT,86355,CPT,302,RC,,,,outpatient,,,50,5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,33.56,33.56,33.56,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,60.77,60.77,60.77,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,37.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,37.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,27.98,27.98,27.98,1 through 10,percent of total billed charges,,,33.6,,33.56,33.56,33.56,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,63.63,63.63,63.63,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,78.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,39.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,33.56,33.56,33.56,25,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,39.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,81.52,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,38.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,37.73,448,,facility
VITAMIN B-1 (THIAMINE) LEVEL,84425,CPT,0301,RC,,,,outpatient,,,67.5,6.75,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,18.88,18.88,18.88,41,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,39.83,39.83,39.83,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,35.9,35.64,35.9,1 through 10,percent of total billed charges,,,33.6,,22.88,22.88,22.88,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,22.85,22.85,22.88,16,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,21.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,44.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,18.88,18.88,18.88,118,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,21.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,45.87,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,21.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,21.23,448,,facility
NUCLEAR ANTIGEN ANTIBODY,86235,CPT,302,RC,,,,outpatient,,,184,18.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13,12.5,15.95,11,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,54.91,4.37,90.29,43,percent of total billed charges,,,33.6,,4.37,4.37,53.09,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,22.18,4.24,83.33,13,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,37.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.95,13,15.95,54,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.75,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.93,448,,facility
ASSAY OF C-PEPTIDE,84681,CPT,301,RC,,,,outpatient,,,537,53.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,18.51,18.51,18.51,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,283.54,283.54,283.54,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,54.1,54.1,54.58,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,20.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,43.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,18.51,18.51,18.51,11,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,20.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,44.98,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,21.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,20.81,448,,facility
CELL FUNCTION ASSAY W/STIM,86352,CPT,302,RC,,,,outpatient,,,558,55.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,135.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,135.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,139.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,210.52,210.52,210.52,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,135.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,283.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,144.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,120.85,120.85,120.85,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,135.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,144.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,293.53,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,138.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,135.86,448,,facility
T CELLS TOTAL COUNT,86359,CPT,302,RC,,,,outpatient,,,282,28.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,33.56,33.56,33.56,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,37.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,37.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,82.68,82.68,82.68,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,78.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,39.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,33.56,33.56,33.56,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,39.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,81.52,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,38.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,37.73,448,,facility
NUCLEAR ANTIGEN ANTIBODY,86235,CPT,302,RC,,,,outpatient,,,341,34.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13,12.5,15.95,11,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,54.91,4.37,90.29,43,percent of total billed charges,,,33.6,,4.37,4.37,53.09,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,22.18,4.24,83.33,13,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,37.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.95,13,15.95,54,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.75,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.93,448,,facility
FLUORESCENT ANTIBODY SCREEN,86255,CPT,302,RC,,,,outpatient,,,1351,135.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.72,10.72,10.72,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,45.41,28.9,1068.67,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,28.9,28.9,28.9,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.72,10.72,10.72,19,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.04,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.05,448,,facility
IMMUNOASSAY TUMOR OTHER,86316,CPT,302,RC,,,,outpatient,,,688,68.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,18.51,18.51,18.51,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,76.03,32.21,76.03,1 through 10,percent of total billed charges,,,33.6,,48.38,48.38,48.38,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,20.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,43.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,18.51,18.51,18.51,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,20.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,44.98,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,21.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,20.81,448,,facility
IMMUNOASSAY TUMOR OTHER,86316,CPT,302,RC,,,,outpatient,,,592,59.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,18.51,18.51,18.51,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,76.03,32.21,76.03,1 through 10,percent of total billed charges,,,33.6,,48.38,48.38,48.38,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,20.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,43.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,18.51,18.51,18.51,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,20.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,44.98,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,21.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,20.81,448,,facility
JOHN CUNNINGHAM ANTIBODY,86711,CPT,302,RC,,,,outpatient,,,60,6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,105.02,105.02,105.02,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,35.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.02,15.02,15.02,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,31.1,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,16.89,448,,facility
HEPATITIS A ANTIBODY,86708,CPT,302,RC,,,,outpatient,,,46,4.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.02,11.02,11.02,30,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,76.16,76.16,76.16,24,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,70.21,70.21,70.21,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,62.83,39.98,62.83,12,percent of total billed charges,,,33.6,,39.98,39.98,62.83,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,39.98,39.98,201.6,23,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,59.5,59.5,59.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.02,11.02,11.02,102,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.76,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.39,448,,facility
VIRUS ANTIBODY NOS,86790,CPT,302,RC,,,,outpatient,,,184,18.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.46,11.46,11.46,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,107.86,20.06,169.49,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,116.52,40.29,122.3,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,26.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.46,11.46,11.46,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.88,448,,facility
MYCOBACTERIC IDENTIFICATION,87118,CPT,306,RC,,,,outpatient,,,750,75,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,30.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.57,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.61,448,,facility
RUBEOLA ANTIBODY,86765,CPT,302,RC,,,,outpatient,,,210,21,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.46,11.46,11.46,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,22.18,22.18,83.95,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,20.68,20.68,20.68,1 through 10,percent of total billed charges,,,34.6,,61.35,61.35,61.35,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,26.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,44,44,44,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.46,11.46,11.46,18,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.88,448,,facility
MYCOPLASMA ANTIBODY,86738,CPT,302,RC,,,,outpatient,,,67,6.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.78,11.78,11.78,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.6,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.24,448,,facility
CHROMOGENIC SUBSTRATE ASSAY,85130,CPT,305,RC,,,,outpatient,,,841,84.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.58,10.58,10.58,11,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,571.12,571.12,571.12,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,277.2,277.2,277.2,1 through 10,percent of total billed charges,,,33.6,,176.4,176.4,176.4,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,24.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.58,10.58,10.58,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.69,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.89,448,,facility
DNA/RNA SEQUENCING,87153,CPT,306,RC,,,,outpatient,,,576,57.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,102.61,102.61,102.61,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,115.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,115.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,118.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,385.39,385.39,385.39,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,115.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,241.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,122.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,115.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,122.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,249.24,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,117.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,115.36,448,,facility
RICKETTSIA ANTIBODY,86757,CPT,302,RC,,,,outpatient,,,40,4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,17.21,17.21,17.21,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,40.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,20.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,17.21,17.21,17.21,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,20.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,41.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,19.35,448,,facility
HEP B CORE ANTIBODY IGM,86705,CPT,302,RC,,,,outpatient,,,417,41.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.47,10.47,10.47,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,78.08,78.08,78.08,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,64.15,64.15,64.15,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,41.19,40.99,41.19,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,24.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.47,10.47,10.47,11,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.45,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.77,448,,facility
ANALYSIS FOR ANTIBODY TO VARICELLA-ZOSTER VIRUS (CHICKEN POX),86787,CPT,0302,RC,,,,outpatient,,,505,50.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.46,11.46,11.46,39,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,82.6,23.01,82.6,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,47.54,20.59,129.19,22,percent of total billed charges,,,33.6,,47.04,47.04,266.64,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,47.04,47.04,47.54,21,percent of total billed charges,,,34.6,,221.19,221.19,221.19,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,26.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,70,70,252.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,24.36,24.36,24.36,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,11.46,11.46,11.46,1 through 10,percent of total billed charges,,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.46,11.46,11.46,200,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.88,448,,facility
VIRUS ANTIBODY NOS,86790,CPT,302,RC,,,,outpatient,,,109,10.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.46,11.46,11.46,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,107.86,20.06,169.49,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,116.52,40.29,122.3,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,26.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.46,11.46,11.46,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.88,448,,facility
TISSUE HOMOGENIZATION CULTR,87176,CPT,306,RC,,,,outpatient,,,89,8.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,12.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.71,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.88,448,,facility
RUBEOLA ANTIBODY,86765,CPT,302,RC,,,,outpatient,,,86,8.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.46,11.46,11.46,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,22.18,22.18,83.95,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,20.68,20.68,20.68,1 through 10,percent of total billed charges,,,34.6,,61.35,61.35,61.35,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,26.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,44,44,44,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.46,11.46,11.46,18,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.88,448,,facility
SC STD AGAR DILUTION PER AGT,87181,CPT,306,RC,,,,outpatient,,,67,6.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,9.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.26,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,4.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,4.75,448,,facility
BLOOD COUNT; HEMOGLOBIN,85018,CPT,0305,RC,,,,outpatient,,,28.25,2.83,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,2.11,2.11,2.11,20,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,17.92,17.92,72.32,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,3.32,3.32,16.52,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,59.66,14.92,94.03,1 through 10,percent of total billed charges,,,33.6,,14.78,14.78,14.92,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,9.41,9.41,37.97,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,4.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,14,14,14,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,2.11,2.11,2.11,57,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.13,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,2.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,2.37,448,,facility
HERPES SIMPLEX TYPE 2 TEST,86696,CPT,302,RC,,,,outpatient,,,244,24.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,17.21,17.21,17.21,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,20.59,20.59,42.71,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,13.1,13.1,13.1,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,40.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,20.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,17.21,17.21,17.21,12,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,20.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,41.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,19.35,448,,facility
EHRLICHIA ANTIBODY,86666,CPT,302,RC,,,,outpatient,,,329,32.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,7.53,7.53,7.53,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,21.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9.05,9.05,9.05,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.98,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,10.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,10.18,448,,facility
GENE REARRANGEMENT ANALYSIS (IMMUNOGLOBULIN HEAVY CHAIN LOCUS) TO DETECT ABNORMAL CLONAL POPULATION AMPLIFIED METHODOLOGY,81261,CPT,0310,RC,,,,outpatient,,,1189,118.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,197.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,197.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,203.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,399.5,399.5,399.5,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,197.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,413.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,209.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,197.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,209.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,427.75,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,201.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,197.99,448,,facility
MOPATH PROCEDURE LEVEL 7,81406,CPT,310,RC,,,,outpatient,,,1970,197,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,282.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,282.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,291.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,282.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,591.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,299.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,282.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,299.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,495.04,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,288.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,282.88,591.22,,facility
DETECT AGENT NOS DNA QUANT,87799,CPT,306,RC,,,,outpatient,,,910,91,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,38.11,38.11,38.11,39,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,44.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,200.64,91.44,597.79,1 through 10,percent of total billed charges,,,33.6,,203.95,203.95,203.95,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,231.27,203.95,231.27,11,percent of total billed charges,,,34.6,,220.34,220.34,231.27,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,89.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,45.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,38.11,38.11,38.11,221,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,45.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,92.54,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,43.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,42.84,448,,facility
MOPATH PROCEDURE LEVEL 7,81406,CPT,310,RC,,,,outpatient,,,1762,176.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,282.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,282.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,291.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,282.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,591.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,299.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,282.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,299.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,495.04,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,288.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,282.88,591.22,,facility
TRICHOMONAS VAGINALIS AMPLIF,87661,CPT,306,RC,,,,outpatient,,,231,23.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,57,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,127.44,127.44,127.44,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,114.05,72.58,123.34,1 through 10,percent of total billed charges,,,33.6,,28.9,28.9,114.05,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,72.58,28.9,73.22,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,91,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
MLH1 GENE DUP/DELETE VARIANT,81294,CPT,310,RC,,,,outpatient,,,222,22.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,202.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,202.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,208.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,202.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,423.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,214.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,202.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,214.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,354.2,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,206.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,202.4,448,,facility
HRDTRY PERPH NEURPHY PANEL,81448,CPT,310,RC,,,,outpatient,,,6275,627.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,584.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,584.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,602.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,584.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1222.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,619.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,584.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,619.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1263.68,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,596.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1263.68,,facility
UNLISTED MOLECULAR PATHOLOGY,81479,CPT,310,RC,,,,outpatient,,,1940,194,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,561.56,561.56,561.56,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,32.5,32.5,3071.5,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
URINALYSIS; MANUAL TEST,81002,CPT,0307,RC,,,,outpatient,,,13,1.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.1,3.1,3.1,63,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,7.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.1,3.1,3.1,277,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.09,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,3.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,3.48,448,,facility
DETECT AGENT NOS DNA QUANT,87799,CPT,306,RC,,,,outpatient,,,300,30,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,38.11,38.11,38.11,39,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,44.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,200.64,91.44,597.79,1 through 10,percent of total billed charges,,,33.6,,203.95,203.95,203.95,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,231.27,203.95,231.27,11,percent of total billed charges,,,34.6,,220.34,220.34,231.27,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,89.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,45.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,38.11,38.11,38.11,221,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,45.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,92.54,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,43.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,42.84,448,,facility
F5 GENE,81241,CPT,310,RC,,,,outpatient,,,713,71.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,65.26,65.26,65.26,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,73.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,73.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,219.41,219.41,219.41,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,73.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,153.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,77.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,65.26,65.26,65.26,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,73.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,77.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,132.02,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,74.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,73.37,448,,facility
MSH6 GENE FULL SEQ,81298,CPT,310,RC,,,,outpatient,,,650,65,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,641.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,641.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,661.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,641.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1341.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,680.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,641.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,680.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1123.24,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,654.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1341.47,,facility
NOONAN SPECTRUM DISORDERS,81442,CPT,310,RC,,,,outpatient,,,3650,365,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2143.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2143.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2207.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2143.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,4480.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2272.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2143.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2272.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3751.3,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,2186.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,4480.12,,facility
BRCA1&2 GEN FULL SEQ DUP/DEL,81162,CPT,310,RC,,,,outpatient,,,1090,109,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1824.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1824.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1879.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1824.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3814,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1934.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1824.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1934.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3942.63,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1861.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3942.63,,facility
NFCT AGT GNTYP ALYS HIV1 REV,87901,CPT,306,RC,,,,outpatient,,,632,63.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,295,295,295,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,257.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,257.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,265.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,264,264,264,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,257.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,538.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,272.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,229,229,229,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,257.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,272.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,556.22,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,262.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,257.45,556.22,,facility
DETECT AGENT NOS DNA QUANT,87799,CPT,306,RC,,,,outpatient,,,410,41,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,38.11,38.11,38.11,39,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,44.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,200.64,91.44,597.79,1 through 10,percent of total billed charges,,,33.6,,203.95,203.95,203.95,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,231.27,203.95,231.27,11,percent of total billed charges,,,34.6,,220.34,220.34,231.27,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,89.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,45.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,38.11,38.11,38.11,221,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,45.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,92.54,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,43.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,42.84,448,,facility
MYD88 GENE P.LEU265PRO VRNT,81305,CPT,310,RC,,,,outpatient,,,1113,111.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,175.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,175.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,180.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,175.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,366.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,185.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,175.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,185.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,306.95,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,178.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,175.4,448,,facility
F5 GENE,81241,CPT,310,RC,,,,outpatient,,,825,82.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,65.26,65.26,65.26,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,73.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,73.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,219.41,219.41,219.41,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,73.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,153.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,77.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,65.26,65.26,65.26,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,73.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,77.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,132.02,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,74.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,73.37,448,,facility
DETECT AGENT NOS DNA QUANT,87799,CPT,306,RC,,,,outpatient,,,763,76.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,38.11,38.11,38.11,39,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,44.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,200.64,91.44,597.79,1 through 10,percent of total billed charges,,,33.6,,203.95,203.95,203.95,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,231.27,203.95,231.27,11,percent of total billed charges,,,34.6,,220.34,220.34,231.27,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,89.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,45.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,38.11,38.11,38.11,221,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,45.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,92.54,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,43.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,42.84,448,,facility
SO/HL 51/>GSAP DNA/DNA&RNA,81455,CPT,310,RC,,,,outpatient,,,9400,940,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2919.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2919.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3007.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2919.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,6101.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3094.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2919.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3094.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5109.3,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,2977.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,6101.96,,facility
MOPATH PROCEDURE LEVEL 6,81405,CPT,310,RC,,,,outpatient,,,299,29.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,301.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,301.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,310.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,301.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,629.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,319.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,301.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,319.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,527.36,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,307.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,301.35,629.82,,facility
DETECT AGENT NOS DNA AMP,87798,CPT,306,RC,,,,outpatient,,,670,67,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,110.88,110.88,174.24,1 through 10,percent of total billed charges,,,33.6,,244.27,244.27,244.27,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,96.77,32.38,119.79,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,38.9,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
DETECT AGENT NOS DNA AMP,87798,CPT,306,RC,,,,outpatient,,,910,91,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,110.88,110.88,174.24,1 through 10,percent of total billed charges,,,33.6,,244.27,244.27,244.27,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,96.77,32.38,119.79,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,38.9,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
CT LOWER EXTREMITY W/DYE,73701,CPT,352,RC,,,,outpatient,,,5157,515.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,403,,,,,,,case rate,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,371,,,,,,,case rate,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,875,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1050,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,172.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,350.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,177.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,92.78,92.78,185.56,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,177.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1522,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,171.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,167.87,1522,,facility
CT SCAN OF BLOOD VESSELS OF ABDOMEN WITH CONTRAST,74175,CPT,0350,RC,,,,outpatient,,,5520,552,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,875,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1050,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,172.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,2914.56,2914.56,2914.56,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,350.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,177.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,177.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1522,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,171.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,167.87,1522,,facility
X-RAY EXAM OF HEEL,73650,CPT,320,RC,,,,outpatient,,,1130,113,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,85.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,174.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,84.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,83.29,448,,facility
TISSUE EXAM BY PATHOLOGIST,88304,CPT,310,RC,,,,outpatient,,,80,8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,51.2,50.12,51.2,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,49.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,49.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,51.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,161.19,120.62,241.25,1 through 10,percent of total billed charges,,,33.6,,120.62,120.62,120.62,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,120.62,120.62,361.87,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,49.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,104.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,52.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,179.5,179.5,179.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,25.61,25.61,26.63,89,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,49.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,52.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,78.23,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,50.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,49.87,448,,facility
CHEMO IV INFUS EACH ADDL SEQ,96417,CPT,335,RC,,,,outpatient,,,833,83.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,62.45,58.46,124.89,396,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,533.12,533.12,1066.24,94,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,491.47,491.47,491.47,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,68.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,68.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,70.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,439.82,439.82,879.65,71,percent of total billed charges,,,33.6,,279.89,279.89,279.89,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,279.89,279.89,559.78,27,percent of total billed charges,,,34.6,,308.21,308.21,308.21,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,68.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,144.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,73.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,174.93,174.93,174.93,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,64.84,63.38,126.76,199,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,68.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,73.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1603,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,70.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,68.91,1603,,facility
ADMINISTRATION OF CHEMOTHERAPY INTO FLUID-FILLED SPACE BETWEEN THE TISSUE THAT COVER THE BRAIN AND SPINAL CORD,96450,CPT,0331,RC,,,,outpatient,,,1873,187.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,291.03,272.45,297.44,28,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,1198.72,1198.72,1198.72,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,316.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,316.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,325.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,316.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,660.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,335.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,393.33,393.33,393.33,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,295.37,295.37,295.37,29,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,316.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,335.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1603,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,322.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,316.12,1603,,facility
X-RAY OF ENTIRE MIDDLE AND LOWER SPINE; 2-3 VIEWS,72082,CPT,0320,RC,,,,outpatient,,,1159,115.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,448,,facility
CT SCAN OF FACE BEFORE AND AFTER CONTRAST,70488,CPT,0351,RC,,,,outpatient,,,7386,738.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,403,,,,,,,case rate,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,371,,,,,,,case rate,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,875,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1050,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,172.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,350.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,177.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,177.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1522,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,171.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,167.87,1522,,facility
SPECIAL STAINS GROUP 2,88313,CPT,310,RC,,,,outpatient,,,287,28.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,117.45,117.45,127.33,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,131.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,1158.42,1158.42,1448.02,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,216.72,216.72,650.16,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,266.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,134.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,322.5,322.5,322.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,56.91,56.91,59.4,38,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,134.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,55.65,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,129.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,55.65,448,,facility
FLOWCYTOMETRY/TC ADD-ON,88185,CPT,311,RC,,,,outpatient,,,2485,248.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,456.96,430.08,1705.1,168,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,52.8,,399.84,399.84,2815.68,17,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,1759.8,1759.8,1759.8,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.72,18.35,330.3,23,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,53.55,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",53.55,448,,facility
IMHCHEM/IMCYTCHM EA ADD ANTB,88341,CPT,310,RC,,,,outpatient,,,645,64.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,253.44,84.48,824.32,63,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,155.76,77.88,233.64,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,432.77,216.38,1514.69,32,percent of total billed charges,,,33.6,,330,209.09,2163.84,23,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,432.77,44.35,1298.3,46,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,25.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,53.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,27.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,1610,1610,1610,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,55.86,53.04,55.86,82,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,25.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,27.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,113.4,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,26.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,25.79,448,,facility
IMFLUOR EA ADDL 1ANTB STN PX,88350,CPT,310,RC,,,,outpatient,,,61,6.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,26.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,55.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,28.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,26.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,28.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,76.23,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,27.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,26.49,448,,facility
REVIEW BY RADIOLOGIST OF ABDOMINAL AORTA AND BOTH LEG ARTERIES IMAGE,75630,CPT,0323,RC,,,,outpatient,,,8474,847.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3021.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3021.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3112.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3021.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,6315.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3203.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3021.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3203.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,3082.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,443,6315.75,,facility
X-RAY OF LOWER LEG; 2 VIEWS,73590,CPT,0320,RC,,,,outpatient,,,823,82.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,85.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,174.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.41,19.41,19.97,77,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,84.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,83.29,448,,facility
IMHCHEM/IMCYTCHM EA ADD ANTB,88341,CPT,310,RC,,,,outpatient,,,132,13.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,253.44,84.48,824.32,63,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,155.76,77.88,233.64,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,432.77,216.38,1514.69,32,percent of total billed charges,,,33.6,,330,209.09,2163.84,23,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,432.77,44.35,1298.3,46,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,25.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,53.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,27.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,1610,1610,1610,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,55.86,53.04,55.86,82,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,25.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,27.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,113.4,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,26.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,25.79,448,,facility
CYTOGENETICS DNA PROBE,88271,CPT,311,RC,,,,outpatient,,,130,13,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.05,19.05,19.05,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,1274.11,1274.11,1274.11,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,477.79,477.79,477.79,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,21.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,44.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.05,19.05,19.05,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,21.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,46.27,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,21.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,21.42,448,,facility
SCREENING 3D BREAST MAMMOGRAPHY,77063,CPT,0403,RC,,,,outpatient,,,89,8.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,40.42,40.42,40.42,488,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,40.42,40.42,40.42,77,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,40.42,40.42,40.42,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,225,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,250,,,,,,,case rate,NTE Percentage + Reimbursement Rate 85.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,26.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,58,38.98,61.25,399,percent of total billed charges,,,33.6,,58,38.98,58,151,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,38.98,30.17,58,181,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,26.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,55.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,28.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,58,44.5,58,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,24.36,24.36,24.36,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,26.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,28.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,429,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,27.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,26.75,448,,facility
REMOVAL OF NONCANCER SKIN GROWTH OF SCALP; NECK; HANDS; FEET; OR GENITALS; 0.6-1.0 CM,11421,CPT,0761,RC,,,,outpatient,,,3201,320.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,617.33,617.33,617.33,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,677.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,677.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,698.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,677.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1416.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,718.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,677.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,718.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,691.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1416.43,,facility
DRAINAGE OF FLUID COLLECTION BY TUBE THROUGH SKIN USING IMAGING GUIDANCE,49405,CPT,0361,RC,,,,outpatient,,,6916,691.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1628.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3303.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1675.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1675.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3821,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1612.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3821,,facility
FOLLOW-UP THERAPY SERVICE TO FACILITATE LUNG FUNCTION,94668,CPT,0410,RC,,,,inpatient,,,321,32.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Short Stay Lesser of + Days Threshold 1.00 + Stoploss First Dollar + Reimbursement Rate 57.00 + Basic Per Diem + Fixed Rate 5000.00 + Fixed Amount 157464.00,,,,0,other,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,Short Stay Lesser of + Days Threshold 1.00 + Stoploss First Dollar + Reimbursement Rate 72.00 + Basic Per Diem + Fixed Rate 10000.00 + Fixed Amount 56687.00,,,,0,other,NTE Percentage + Reimbursement Rate 85.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,47.3,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.26,31.26,31.26,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,facility
3D BREAST MAMMOGRAPHY OF 1 BREAST,77061,CPT,0401,RC,,,,outpatient,,,83,8.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,225,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,250,,,,,,,case rate,NTE Percentage + Reimbursement Rate 85.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,429,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,225,448,,facility
FOLLOW-UP ULTRASOUND SCAN OF FETAL HEART BLOOD FLOW,76828,CPT,0402,RC,,,,outpatient,,,1145,114.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,842.88,842.88,842.88,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,695.38,695.38,695.38,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,17.79,17.79,17.79,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,465,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,465,,facility
STRAPPING; UNNA BOOT,29580,CPT,0761,RC,,,,outpatient,,,354,35.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,155.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,155.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,160.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,155.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,325.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,164.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,155.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,164.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,158.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,155.52,448,,facility
COLLECTION OF STEM CELLS FOR TRANSPLANTATION,38206,CPT,0362,RC,,,,outpatient,,,5615,561.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,1438.32,1438.32,1438.32,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,1490.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1490.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1535.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,2084.88,2084.88,2084.88,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1490.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3115.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1579.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,1459.8,1459.8,1459.8,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1490.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1579.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1520.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3115.25,,facility
ULTRASOUND SCAN OF SCROTUM,76870,CPT,0402,RC,,,,outpatient,,,1720,172,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,1100.8,1100.8,1100.8,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,982.12,577.92,982.12,1 through 10,percent of total billed charges,,,33.6,,577.92,577.92,982.12,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,577.92,577.92,577.92,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,56.35,56.35,58.57,34,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,465,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,465,,facility
PT RE-EVAL EST PLAN CARE,97164,CPT,424,RC,,,,outpatient,,,463,46.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,51.96,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,89.84,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,80,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,63.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,63.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,65.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,63.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,133.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,67.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,63.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,67.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,422,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,64.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,51.96,448,,facility
INSERTION OF TUBE IN LEFT LOWER HEART CHAMBER; CORONARY ARTERY AND BYPASS GRAFT FOR DIAGNOSIS WITH REVIEW BY RADIOLOGIST,93459,CPT,0480,RC,,,,outpatient,,,24932,2493.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2004,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,2759,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 6500.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 10000.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,3102.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3102.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3195.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3102.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,6484.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3288.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3102.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3288.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1463,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,3164.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,1463,6484.66,,facility
ZOLEDRONIC ACID 1MG,J3489,HCPCS,636,RC,,,,outpatient,,,63,6.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,161.28,51.74,201.6,25,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,52.8,,399.17,83.16,399.17,41,percent of total billed charges,,,33.6,,105.84,105.84,105.84,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,84.67,27.17,862.6,122,percent of total billed charges,,,34.6,,57.17,57.17,60.01,16,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",448,448,,facility
"INJ, ADO-TRASTUZUMAB EMT 1MG",J9354,HCPCS,636,RC,,,,outpatient,,,143,14.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,43.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,43.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,44.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,10866.23,10866.23,10866.23,193,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,43.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,91.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,46.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,43.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,46.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,88.09,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,44.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,43.63,448,,facility
DTAP-IPV-HIB-HEPB VACCINE IM,90697,CPT,636,RC,,,,outpatient,,,391,39.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
"INJECTION, DARATUMUMAB 10 MG",J9145,HCPCS,636,RC,,,,outpatient,,,227,22.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,73.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,73.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,73.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,154.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,78.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,73.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,78.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,140.44,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,75.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,73.77,448,,facility
DACARBAZINE 100 MG INJ,J9130,HCPCS,636,RC,,,,outpatient,,,13,1.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",448,448,,facility
MRI SCAN OF MIDDLE SPINAL CANAL WITHOUT CONTRAST,72146,CPT,0612,RC,,,,outpatient,,,8794,879.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,464.74,464.74,474.04,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,786,,,,,,,case rate,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,728,,,,,,,case rate,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,6419.62,99.15,6419.62,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1025,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1350,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,235.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,4643.23,4643.23,5021.37,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,2954.78,2954.78,2954.78,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,477.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,242.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,4397,4397,4397,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,100.34,100.34,100.34,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,242.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2407,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,232.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,228.36,2407,,facility
RSV MONOC ANTB SEASN 1 ML IM,90381,CPT,636,RC,,,,outpatient,,,555,55.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
MRI SCAN OF ABDOMEN WITHOUT CONTRAST,74181,CPT,0610,RC,,,,outpatient,,,6431,643.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,786,,,,,,,case rate,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,728,,,,,,,case rate,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1025,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1350,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,235.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,477.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,242.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,242.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2407,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,232.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,228.36,2407,,facility
HEPA VACC PED/ADOL 2 DOSE IM,90633,CPT,636,RC,,,,outpatient,,,90,9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",448,448,,facility
DTAP-IPV VACCINE 4-6 YRS IM,90696,CPT,636,RC,,,,outpatient,,,373,37.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",448,448,,facility
MMR VACCINE SC,90707,CPT,636,RC,,,,outpatient,,,307,30.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",448,448,,facility
INJECTION OF DRUG INTO ERECTILE TISSUE AT SIDES AND BACK OF PENIS,54220,CPT,0450,RC,,,,outpatient,,,650,65,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,213.4,213.4,213.4,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,239.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,239.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,246.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,239.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,499.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,253.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,239.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,253.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,243.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,239.12,1173,,facility
INJ IRINOTECAN LIPOSOME 1 MG,J9205,HCPCS,636,RC,,,,outpatient,,,204,20.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,65.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,65.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,67.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,65.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,137.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,69.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,65.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,69.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,138.07,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,67.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,65.86,448,,facility
OTHER PROCEDURE ON TONGUE OR FLOOR OF MOUTH,41599,CPT,0450,RC,,,,outpatient,,,629,62.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,226.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,226.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,233.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,226.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,473.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,240.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,226.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,240.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,231.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,226.68,473.76,,facility
REMOVAL OF NONCANCER SKIN GROWTH OF SCALP; NECK; HANDS; FEET; OR GENITALS; 1.1-2.0 CM,11422,CPT,0761,RC,,,,outpatient,,,3143,314.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,1421.6,1421.6,1487.27,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1628.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3303.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1675.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,1442.85,1442.85,1442.85,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1675.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,1612.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3303.62,,facility
DESTRUCTION OF CANCER SKIN GROWTH OF TRUNK; ARMS; OR LEGS; 1.1-2.0 CM,17262,CPT,0761,RC,,,,outpatient,,,1742,174.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,174.34,174.34,174.34,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,197.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,401.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,203.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,203.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,195.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,192.01,1173,,facility
REPAIR OF WOUND OF EYELIDS; NOSE; EARS; OR LIPS BY TRANSFERRING SKIN; 10.1-30.0 SQ CM,14061,CPT,0761,RC,,,,outpatient,,,3143,314.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,1604.98,1604.98,1604.98,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,1027,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1519,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1974.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1974.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2033.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1974.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,4127.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2093.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1974.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2093.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,2014.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,4127.08,,facility
REPLACEMENT OF STOMACH STOMA TUBE WITH REVISION OF STOMA OPENING,43763,CPT,0750,RC,,,,outpatient,,,827,82.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,239.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,239.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,246.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,239.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,499.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,253.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,239.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,253.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2440,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,243.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,239.12,2440,,facility
ESTABLISHED PATIENT PERIODIC PREVENTIVE MEDICINE EXAMINATION (65 YEAR OLD OR OLDER),99397,CPT,0770,RC,,,,outpatient,,,462,46.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
INTERMEDIATE REPAIR OF WOUND OF NECK; HANDS; FEET; OR GENITALS; 2.5 CM OR LESS,12041,CPT,0450,RC,,,,outpatient,,,1108,110.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,350.55,328.18,358.86,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,400.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,813.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,412.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,366.07,355.79,366.07,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,412.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,396.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,389.05,1173,,facility
REMOVAL OF CANCER SKIN GROWTH OF BODY; ARMS; OR LEGS; 3.1-4.0 CM,11604,CPT,0761,RC,,,,outpatient,,,3201,320.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,677.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,677.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,698.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,677.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1416.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,718.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,677.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,718.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,691.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1416.43,,facility
DRAINAGE OF ABSCESS OF SCROTUM,55100,CPT,0450,RC,,,,outpatient,,,3201,320.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,1421.6,1421.6,1421.6,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1628.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3303.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1675.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1675.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1612.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3303.62,,facility
COMPLICATED OR MULTIPLE DRAINAGE OF SKIN ABSCESS,10061,CPT,0450,RC,,,,outpatient,,,1210,121,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,350.55,350.55,350.55,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,400.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,813.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,412.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,355.79,355.79,366.07,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,412.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,396.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,389.05,1173,,facility
COLLECTION OF BLOOD SAMPLE FROM IMPLANTED DEVICE,36591,CPT,0300,RC,,,,outpatient,,,437,43.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,131.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,266.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,134.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,134.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,129.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,127.33,448,,facility
DESTRUCTION OF CANCER SKIN GROWTH OF TRUNK; ARMS; OR LEGS; 3.1-4.0 CM,17264,CPT,0761,RC,,,,outpatient,,,2910,291,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,400.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,813.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,412.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,412.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,396.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,389.05,1173,,facility
DIAGNOSTIC EXAM OF SMALL BOWEL (EXCLUDING LOWER SMALL INTESTINE) USING AN ENDOSCOPE,44360,CPT,0750,RC,,,,outpatient,,,8621,862.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,1664.42,1664.42,1664.42,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,1836.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1836.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1891.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1836.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3838.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1946.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1836.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1946.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3821,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1873.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3838.31,,facility
BALLOON DILATION OF LOWER LARGE BOWEL USING A FLEXIBLE ENDOSCOPE,45340,CPT,0750,RC,,,,outpatient,,,5360,536,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1179.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,2393.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1213.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,1049.99,1049.99,1049.99,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1213.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3821,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1168.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3821,,facility
COLLECTION OF BLOOD SAMPLE FROM CENTRAL VENOUS TUBE,36592,CPT,0300,RC,,,,outpatient,,,825,82.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,131.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,266.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,134.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,114.79,114.79,114.79,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,134.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,129.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,127.33,448,,facility
ACNE SURGERY,10040,CPT,0761,RC,,,,outpatient,,,1742,174.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,197.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,401.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,203.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,176.95,176.95,176.95,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,203.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,195.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,192.01,448,,facility
CLOSED TREATMENT OF DISLOCATED SHOULDER WITH MANIPULATION,23650,CPT,0450,RC,,,,outpatient,,,2910,291,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,243.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,493.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,213.62,213.62,213.62,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,240.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,236.08,1173,,facility
REMOVAL OF FOREIGN BODY FROM EXTERNAL EYE (CONJUNCTIVA),65205,CPT,0450,RC,,,,outpatient,,,3201,320.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,131.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,266.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,134.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,134.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,129.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,127.33,448,,facility
DIAGNOSTIC EXAM OF ANUS USING AN ENDOSCOPE,46600,CPT,0750,RC,,,,outpatient,,,564,56.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,131.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,266.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,134.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,35.36,35.36,35.36,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,134.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2440,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,129.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,127.33,2440,,facility
MUSC TEST DONE W/N TEST COMP,95886,CPT,922,RC,,,,outpatient,,,558,55.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,43.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,43.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,44.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,43.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,90.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,46.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,39.67,39.67,79.34,22,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,43.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,46.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,478,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,44.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,43.45,478,,facility
APHERESIS PLATELETS,36513,CPT,940,RC,,,,outpatient,,,7832,783.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,422.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,422.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,434.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,422.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,882.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,447.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,422.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,447.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,418,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,430.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,418,1311,,facility
ELECTRONIC ANALYSIS OF IMPLANTED NEUROSTIMULATOR GENERATOR WITH COMPLEX CRANIAL NERVE STIMULATOR PROGRAMMING,95977,CPT,0920,RC,,,,outpatient,,,326,32.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,90.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,90.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,93.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,90.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,190.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,96.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,90.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,96.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,422,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,92.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,90.99,448,,facility
SARSCOV2&INF A&B&RSV AMP PRB,87637,CPT,306,RC,,,,outpatient,,,232,23.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,126.87,126.87,126.87,915,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,142.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,142.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,146.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,185,108.86,185.01,29,percent of total billed charges,,,33.6,,108.86,108.86,185.01,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,108.86,108.86,108.86,17,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,142.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,298.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,151.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,68.04,68.04,68.04,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,126.87,126.87,126.87,793,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,142.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,151.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,249.55,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,145.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,142.63,448,,facility
CLTX METATARSAL FX W/MNPJ EA,28475,CPT,450,RC,,,,outpatient,,,280.86,28.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,243.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,493.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,240.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,236.08,1173,,facility
HL NEO GSAP 5-50DNA/DNA&RNA,81450,CPT,310,RC,,,,outpatient,,,949.41,94.94,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,759.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,759.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,782.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,759.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1587.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,805.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,759.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,805.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1329.18,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,774.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1587.42,,facility
CHEMO IV INFUS EACH ADDL SEQ,96417,CPT,335,RC,,,,outpatient,,,83.9,8.39,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,62.45,58.46,124.89,396,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,533.12,533.12,1066.24,94,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,491.47,491.47,491.47,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,68.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,68.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,70.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,439.82,439.82,879.65,71,percent of total billed charges,,,33.6,,279.89,279.89,279.89,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,279.89,279.89,559.78,27,percent of total billed charges,,,34.6,,308.21,308.21,308.21,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,68.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,144.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,73.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,174.93,174.93,174.93,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,64.84,63.38,126.76,199,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,68.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,73.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1603,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,70.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,68.91,1603,,facility
COLONOSCOPY AND BIOPSY,45380,CPT,750,RC,,,,outpatient,,,1405.45,140.55,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,1034.53,968.51,1056.38,45,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1179.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,2362.63,1768.03,2362.64,13,percent of total billed charges,,,33.6,,1768.03,1768.03,1768.03,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,1768.03,1651.95,1768.03,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,2393.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1213.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,2631,2631,2631,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,1049.99,1049.99,1077.58,53,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1213.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3821,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1168.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3821,,facility
US EXAM INFANT HIPS DYNAMIC,76885,CPT,402,RC,,,,outpatient,,,108.23,10.82,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,85.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,174.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,70.18,70.18,70.18,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,465,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,84.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,83.29,465,,facility
GLUCOSE TEST,82950,CPT,301,RC,,,,outpatient,,,5.94,0.59,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.23,4.23,4.23,314,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,37.76,34.96,37.92,33,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,34.81,34.81,34.81,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,31.15,19.82,89.04,20,percent of total billed charges,,,33.6,,19.82,19.82,139.92,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,19.82,19.82,20.09,38,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,9.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,29.63,29.5,132.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,15.07,15.07,15.07,1 through 10,percent of total billed charges,,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.23,4.23,4.23,279,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.26,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,4.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,4.75,448,,facility
HERED RTA DO GEN SEQ 15,81434,CPT,310,RC,,,,outpatient,,,747.39,74.74,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,597.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,597.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,615.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,597.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1249.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,633.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,597.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,633.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1046.34,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,609.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1249.63,,facility
"INJ., RITUXIMAB, 10 MG",J9312,HCPCS,636,RC,,,,outpatient,,,97.09,9.71,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,73.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,73.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,73.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,153.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,77.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,73.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,77.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,164.97,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,74.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,73.28,448,,facility
ASSAY OF CALCIUM,82310,CPT,301,RC,,,,outpatient,,,6.45,0.65,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.59,4.59,4.59,15,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,28.32,28.32,28.32,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,16.13,16.13,50.25,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,16.13,16.13,114.24,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,10.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,71.4,71.4,71.4,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.59,4.59,4.59,27,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.15,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.16,448,,facility
"BRACHYTX, NS, NON-HDRIR-192",C1719,HCPCS,278,RC,,,,outpatient,,,435.53,43.55,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,66,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,61,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,904.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,904.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,931.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,904.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1889.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,958.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,904.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,958.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,922.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,904.25,1889.88,,facility
PROCTOSIGMOIDOSCOPY DX,45300,CPT,750,RC,,,,outpatient,,,1088.51,108.85,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,890.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,890.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,916.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,890.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1860.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,943.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,890.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,943.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2712,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,907.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,2712,,facility
UNLISTED CHEMOTHERAPY PX,96549,CPT,330,RC,,,,outpatient,,,56.58,5.66,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,107.52,107.52,123.52,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,44.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,44.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,46.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,56.95,56.95,56.95,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,44.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,93.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,47.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,44.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,47.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1205,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,45.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,44.82,1205,,facility
THROMBIN TIME PLASMA,85670,CPT,305,RC,,,,outpatient,,,7.21,0.72,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,12.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.46,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.77,448,,facility
L HRT ART/GRFT ANGIO,93459,CPT,480,RC,,,,outpatient,,,3880.91,388.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2004,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,2759,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,3102.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3102.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3195.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3102.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,6484.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3288.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3102.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3288.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1463,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,3164.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,1463,6484.66,,facility
X-RAY EXAM SI JOINTS 3/> VWS,72202,CPT,320,RC,,,,outpatient,,,130.94,13.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,928.64,928.64,928.64,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,487.54,487.54,487.54,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,448,,facility
COMPLEMENT ANTIGEN,86160,CPT,302,RC,,,,outpatient,,,134,13.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.67,10.67,10.67,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,87.32,87.32,87.32,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,78.14,49.73,270.86,17,percent of total billed charges,,,33.6,,49.73,49.73,172.37,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,49.73,29.23,50.32,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,256.5,256.5,256.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.67,10.67,10.67,61,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.92,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12,448,,facility
AMINO ACIDS QUAN 6 OR MORE,82139,CPT,301,RC,,,,outpatient,,,225,22.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.01,12,15.01,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,230.18,110.21,262.42,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,35.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,164.01,164.01,164.01,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.01,12,15.01,16,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.45,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,16.87,448,,facility
NERVE CONDUCTION; 13 OR MORE STUDIES,95913,CPT,0922,RC,,,,outpatient,,,1851,185.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,465.55,329.42,504.72,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,357.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,357.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,367.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,357.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,746.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,378.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,81.45,81.45,85.76,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,357.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,378.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,478,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,364.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,357.13,746.4,,facility
US EXAM PELVIC LIMITED,76857,CPT,402,RC,,,,outpatient,,,138.99,13.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,93.3,92.3,100.06,25,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,566.4,51.66,566.4,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,401.79,401.79,401.79,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,467.28,297.36,505.34,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,297.36,230.86,297.36,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,442.5,442.5,442.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,21.56,21.56,21.91,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,465,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,465,,facility
ASSAY OF GGT,82977,CPT,301,RC,,,,outpatient,,,3,0.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,6.4,6.4,6.4,117,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,231.28,231.28,231.28,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,223.83,36.43,223.83,54,percent of total billed charges,,,33.6,,131.71,23.18,206.98,13,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,23.39,23.18,132.89,33,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,6.4,6.4,6.4,1 through 10,percent of total billed charges,,7.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,15.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,7.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,196,34.5,196,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,6.4,6.4,6.4,714,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,7.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,7.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.56,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,7.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,7.2,448,,facility
BREAST TOMOSYNTHESIS BI,77062,CPT,401,RC,,,,outpatient,,,150,15,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,120.47,106,120.47,33,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,120.47,71.98,120.47,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,225,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,250,,,,,,,case rate,NTE Percentage + Reimbursement Rate 85.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,61,40.99,64.42,30,percent of total billed charges,,,33.6,,61,40.99,61,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,53,35.93,61,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,25.62,25.62,61,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,429,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,225,448,,facility
HC ANES GENERAL ADDL 30MIN,3.7E+12,CDM,370,RC,,,,outpatient,,,150,15,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",448,448,,facility
TYMPANOMETRY,92567,CPT,471,RC,,,,outpatient,,,105,10.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,74.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,425,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,36.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.74,448,,facility
HEMOGLOBIN GLYCOSYLATED A1C,83036,CPT,301,RC,,,,outpatient,,,59,5.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,8.64,8.64,8.64,577,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,34.22,33.93,128.62,24,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,30.62,19.49,115.1,181,percent of total billed charges,,,33.6,,19.49,19.49,73.25,32,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,19.49,19.49,19.49,332,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,9.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,20.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,29,28.75,29,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,12.18,12.08,45.78,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,8.64,8.64,8.64,1 through 10,percent of total billed charges,,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,8.64,8.64,8.64,1281,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,9.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.98,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,9.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,9.71,448,,facility
COMPLETE CBC W/AUTO DIFF WBC,85025,CPT,305,RC,,,,outpatient,,,34,3.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,6.91,6.91,6.91,1297,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,36.48,36.16,237.44,624,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,33.63,33.34,218.89,55,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,36.16,36.16,36.16,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,124.66,19.15,211.84,728,percent of total billed charges,,,33.6,,124.66,19.15,195.89,174,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,19.15,19.15,125.77,706,percent of total billed charges,,,34.6,,134.67,21.53,141.35,26,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,7.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,16.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,28.5,28.25,185.5,63,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,77.91,11.97,77.91,28,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,0.22,0.22,0.22,1 through 10,percent of total billed charges,,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,6.91,6.91,6.91,5659,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,7.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.78,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,7.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,7.77,448,,facility
X-RAY EXAM OF SHOULDER,73030,CPT,320,RC,,,,outpatient,,,108.23,10.82,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,85.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,174.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,20.75,20.75,21.64,56,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,84.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,83.29,448,,facility
LEUPROLIDE ACETATE /3.75 MG,J1950,HCPCS,636,RC,,,,outpatient,,,2092.42,209.24,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,1841.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1841.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1896.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1841.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3848.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1951.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1841.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1951.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3583.58,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1878.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3848.23,,facility
COLPOSCOPY VULVA,56820,CPT,761,RC,,,,outpatient,,,237.33,23.73,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,193.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,193.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,199.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,193.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,404.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,205.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,193.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,205.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,197.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,193.49,1173,,facility
MTHFR GENE,81291,CPT,310,RC,,,,outpatient,,,81.68,8.17,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,65.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,65.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,67.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,65.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,136.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,69.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,65.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,69.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,114.35,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,66.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,65.34,448,,facility
LACTOFERRIN FECAL (QUANT),83631,CPT,301,RC,,,,outpatient,,,24.54,2.45,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,41.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,20.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,20.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.42,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,20.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,19.63,448,,facility
HETEROPHILE ANTIBODY SCREEN,86308,CPT,302,RC,,,,outpatient,,,6.48,0.65,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.61,4.61,4.61,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,138.77,138.77,224.4,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,133.23,133.23,133.23,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,10.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.61,4.61,4.61,39,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.18,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.18,448,,facility
TRLUML BALO ANGIOP 1ST ART,37246,CPT,361,RC,,,,outpatient,,,6807.3,680.73,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5447.15,5002.54,5447.15,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,2004,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,2759,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,5447.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5447.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5610.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5447.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,11384.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5773.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5447.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5773.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11062,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5556.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,11384.54,,facility
TREAT FINGER FRACTURE EACH,26750,CPT,761,RC,,,,outpatient,,,280.86,28.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,243.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,493.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,240.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,236.08,493.41,,facility
LAPAROSCOPIC CHOLECYSTECTOMY,47562,CPT,360,RC,,,,outpatient,,,6871.99,687.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5119.1,4792.4,5444.03,18,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,1445,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,2070,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,5785.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5785.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5959.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5785.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,12092.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6133.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5195.58,5195.58,5444.03,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5785.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6133.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11062,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5901.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,12092.57,,facility
MRI ABDOMEN W/O CONTRAST,74181,CPT,610,RC,,,,outpatient,,,291.84,29.18,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,786,,,,,,,case rate,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,728,,,,,,,case rate,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1025,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1350,,,,,,,case rate,NTE Percentage + Reimbursement Rate 85.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,235.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,477.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,242.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,242.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2407,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,232.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,228.36,2407,,facility
ADENOVIRUS AG IF,87260,CPT,306,RC,,,,outpatient,,,18.04,1.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,30.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.9,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.43,448,,facility
ESOPHAGOSCOPY SNARE LES REMV,43217,CPT,750,RC,,,,outpatient,,,2266.24,226.62,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,1836.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1836.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1891.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1836.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3838.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1946.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1836.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1946.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3821,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1873.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3838.31,,facility
"ASY CARBAMAZEPIN 10,11-EPXID",80161,CPT,301,RC,,,,outpatient,,,23.3,2.33,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.62,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.64,448,,facility
QUAN MR TIS WO MRI MLT ORGN,0697T,CPT,610,RC,,,,outpatient,,,1188.13,118.81,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1025,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1350,,,,,,,case rate,NTE Percentage + Reimbursement Rate 85.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,894.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,894.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,921.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,894.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1870.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,948.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,894.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,948.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2407,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,912.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,2407,,facility
REMOVE INTRVAS FOREIGN BODY,37197,CPT,361,RC,,,,outpatient,,,3796.26,379.63,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1027,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1519,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,3021.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3021.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3112.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3021.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,6315.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3203.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3021.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3203.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10137,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,3082.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,10137,,facility
GI TRC IMG INTRAL ESOPH-ILE,91110,CPT,750,RC,,,,outpatient,,,1079.61,107.96,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,868.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,868.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,894.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,868.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1814.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,920.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,474.64,474.64,474.64,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,868.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,920.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3821,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,885.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3821,,facility
COLONOSCOPY W/DECOMPRESSION,45393,CPT,750,RC,,,,outpatient,,,1405.45,140.55,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1179.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,2393.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1213.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1213.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3821,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1168.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3821,,facility
ASSAY OF CRYOFIBRINOGEN,82585,CPT,301,RC,,,,outpatient,,,17.68,1.77,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,29.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.58,12.58,12.58,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.75,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.14,448,,facility
MRI PELVIS W/O DYE,72195,CPT,610,RC,,,,outpatient,,,291.84,29.18,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,786,,,,,,,case rate,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,728,,,,,,,case rate,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1025,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1350,,,,,,,case rate,NTE Percentage + Reimbursement Rate 85.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,235.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,2944.13,1873.54,2944.13,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,1873.54,1873.54,1873.54,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,477.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,242.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,242.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2407,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,232.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,228.36,2407,,facility
EKG TRACING FOR INITIAL PREV,G0404,HCPCS,730,RC,,,,outpatient,,,35.46,3.55,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,27.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,57.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,29.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,27.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,29.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,389,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,28.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,27.68,448,,facility
ASSAY OF IRON,83540,CPT,301,RC,,,,outpatient,,,8.09,0.81,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.75,5.75,5.75,336,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,19.18,19.18,60.77,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,17.42,11.09,54.38,99,percent of total billed charges,,,33.6,,11.09,11.09,54.38,18,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,11.09,11.02,34.61,116,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,13.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,16.5,16.5,16.5,11,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.75,5.75,5.75,876,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.98,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,6.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,6.47,448,,facility
APPLICATON ON-BODY INJECTOR,96377,CPT,260,RC,,,,outpatient,,,56.58,5.66,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,41.34,40.48,44.82,14,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,44.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,44.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,46.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,44.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,93.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,47.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,29.94,29.94,29.94,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,44.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,47.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,427,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,45.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,44.82,1173,,facility
COMPOSITE SKIN GRAFT,15760,CPT,761,RC,,,,outpatient,,,2171.91,217.19,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1974.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1974.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2033.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1974.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,4127.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2093.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1974.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2093.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,2014.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,4127.08,,facility
URINALYSIS NONAUTO W/SCOPE,81000,CPT,307,RC,,,,outpatient,,,5.03,0.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,8.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.04,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,4.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,4.02,448,,facility
GALECTIN-3,82777,CPT,301,RC,,,,outpatient,,,55.31,5.53,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,44.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,44.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,45.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,44.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,92.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,46.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,44.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,46.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,77.44,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,45.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,44.25,448,,facility
IMMUNE COMPLEX ASSAY,86332,CPT,302,RC,,,,outpatient,,,30.46,3.05,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,24.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,50.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,25.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,24.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,25.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,52.66,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,24.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,24.37,448,,facility
ASSAY OF LDH ENZYMES,83625,CPT,301,RC,,,,outpatient,,,15.99,1.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,26.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.65,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.79,448,,facility
ASSAY OF AMMONIA,82140,CPT,301,RC,,,,outpatient,,,18.21,1.82,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.96,12.96,12.96,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,65.18,29.57,110.77,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,29.92,29.92,29.92,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,30.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.96,12.96,12.96,51,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,31.48,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.57,448,,facility
COLONOSCOPY THRU STOMA SPX,44388,CPT,750,RC,,,,outpatient,,,1088.51,108.85,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,799.94,399.97,811.89,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,890.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,890.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,916.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,890.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1860.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,943.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,405.95,405.95,811.89,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,890.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,943.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3821,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,907.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3821,,facility
ASSAY OF BLOOD FATTY ACIDS,82725,CPT,301,RC,,,,outpatient,,,23.46,2.35,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,39.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.85,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.77,448,,facility
QUAN US TIS CHARAC W/O DX US,0689T,CPT,402,RC,,,,outpatient,,,108.23,10.82,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,85.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,174.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,465,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,84.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,83.29,465,,facility
ASSAY ACTIVATED PROTEIN C,85307,CPT,305,RC,,,,outpatient,,,19.15,1.92,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,32.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.63,13.63,13.63,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,33.11,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,15.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,15.32,448,,facility
BLM GENE,81209,CPT,310,RC,,,,outpatient,,,49.14,4.91,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,39.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,39.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,40.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,39.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,82.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,41.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,39.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,41.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,68.79,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,40.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,39.31,448,,facility
REMOVE EYELID FOREIGN BODY,67938,CPT,450,RC,,,,outpatient,,,346.95,34.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,303.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,303.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,312.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,303.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,634.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,322,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,303.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,322,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,309.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,303.77,1173,,facility
CSTB GENE FULL GENE SEQUENCE,81189,CPT,310,RC,,,,outpatient,,,343.54,34.35,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,274.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,274.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,283.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,274.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,574.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,291.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,274.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,291.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,480.95,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,280.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,274.83,574.39,,facility
BCKDHB GENE,81205,CPT,310,RC,,,,outpatient,,,118.74,11.87,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,94.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,94.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,97.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,94.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,198.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,94.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,166.23,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,96.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,94.99,448,,facility
CACNA1A GEN DETC ABNOR ALLEL,81184,CPT,310,RC,,,,outpatient,,,171.25,17.13,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,137,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,137,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,141.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,137,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,286.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,145.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,137,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,145.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,239.75,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,139.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,137,448,,facility
EVALUATION OF WHEEZING,94070,CPT,460,RC,,,,outpatient,,,373.83,37.38,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,273.22,273.22,296.21,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,2748.8,2748.8,2748.8,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,357.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,357.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,367.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,357.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,746.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,378.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,29.37,29.37,29.37,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,357.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,378.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,611,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,364.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,357.13,746.4,,facility
REVISION OF NOSE,30120,CPT,761,RC,,,,outpatient,,,3834.53,383.45,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3173.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3173.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3268.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3173.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,6631.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3363.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3173.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3363.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,3236.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,6631.76,,facility
3-D RADIOTHERAPY PLAN,77295,CPT,333,RC,,,,outpatient,,,1650.26,165.03,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,7868.8,7868.8,7868.8,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1324.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1324.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1364.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,4131.12,4131.12,4131.12,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,4131.12,4131.12,4168.01,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1324.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,2768.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1404.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1324.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1404.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,48815,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1351.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,48815,,facility
ASSAY SERUM CHOLINESTERASE,82480,CPT,301,RC,,,,outpatient,,,9.84,0.98,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,7.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,16.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,7.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.01,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,8.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,7.87,448,,facility
GAS DIL/WSHOT DETER LNG VOL,94727,CPT,460,RC,,,,outpatient,,,186.04,18.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,291.2,291.2,378.88,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,206.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,206.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,212.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,312.58,198.91,312.58,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,154.25,154.25,154.25,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,206.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,431.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,219.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,26.96,26.96,27.47,11,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,206.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,219.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,611,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,210.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,206.65,611,,facility
I&D ABSCESS PERITONSILLAR,42700,CPT,761,RC,,,,outpatient,,,290.91,29.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,226.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,226.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,233.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,226.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,473.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,240.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,226.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,240.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,231.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,226.68,1173,,facility
NEISSERIA MENINGITIDIS,86741,CPT,302,RC,,,,outpatient,,,16.49,1.65,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.49,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.19,448,,facility
BIOPSY OF OVARY(S),58900,CPT,761,RC,,,,outpatient,,,3723.46,372.35,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1027,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1519,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3098.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3098.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3191.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3098.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,6475.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3284,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3098.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3284,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,3160.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,6475.05,,facility
ASSAY OF ETHYLENE GLYCOL,82693,CPT,301,RC,,,,outpatient,,,18.63,1.86,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,31.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.25,13.25,13.25,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.2,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,15.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.9,448,,facility
ORGANIC ACIDS TOTAL QUANT,83918,CPT,301,RC,,,,outpatient,,,29.5,2.95,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,23.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,23.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,23.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,49.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,25.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,23.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,25.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,41.3,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,24.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,23.6,448,,facility
UMBILICAL ARTERY ECHO,76820,CPT,402,RC,,,,outpatient,,,130.94,13.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.71,16.71,16.71,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,465,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,465,,facility
ALYS BRN NPGT PRGRMG 15 MIN,95983,CPT,920,RC,,,,outpatient,,,115.29,11.53,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,80.53,80.53,83.93,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,90.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,90.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,93.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,90.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,190.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,96.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,41.94,41.94,43.42,14,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,90.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,96.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,422,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,92.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,90.99,448,,facility
X-RAY XM COLON 1CNTRST STD,74270,CPT,320,RC,,,,outpatient,,,218.83,21.88,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,1539.84,1539.84,1539.84,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,1419.54,1419.54,1419.54,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,172.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,1270.37,815.63,1270.37,1 through 10,percent of total billed charges,,,33.6,,808.42,808.42,808.42,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,350.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,177.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,177.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,171.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,167.87,448,,facility
FATS/LIPIDS FECES QUAL,82705,CPT,301,RC,,,,outpatient,,,6.38,0.64,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,10.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.54,4.54,4.54,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.01,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.1,448,,facility
INSERT/PLACE HEART CATHETER,93503,CPT,481,RC,,,,outpatient,,,1907.41,190.74,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,1506.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1506.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1551.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1506.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3148.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1596.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1506.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1596.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2712,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1536.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,669,3148.69,,facility
DRUG ASSAY FELBAMATE,80167,CPT,301,RC,,,,outpatient,,,23.3,2.33,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.62,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.64,448,,facility
CLTX ULNAR SHFT FX W/MNPJ,25535,CPT,761,RC,,,,outpatient,,,280.86,28.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,243.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,493.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,240.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,236.08,1173,,facility
PENILE VASCULAR STUDY,93981,CPT,921,RC,,,,outpatient,,,130.94,13.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1227,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,1227,,facility
"INJ., BENDEKA 1 MG",J9034,HCPCS,636,RC,,,,outpatient,,,17.02,1.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,10306.84,10306.84,10306.84,775,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,12.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,26.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.92,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.53,448,,facility
RADIATION TREATMENT AID(S),77332,CPT,333,RC,,,,outpatient,,,161.6,16.16,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,128.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,128.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,132.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,557.09,557.09,557.09,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,128.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,268.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,136.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,128.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,136.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,48815,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,131.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,128.64,48815,,facility
IMMUNOASSAY TUMOR CA 125,86304,CPT,302,RC,,,,outpatient,,,26.01,2.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,18.51,18.51,18.51,13,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,29.13,29.13,29.13,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,195.36,59.14,195.36,12,percent of total billed charges,,,33.6,,59.14,59.14,125.43,21,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,124.32,37.63,125.43,21,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,20.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,43.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,185,56.13,185,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,77.7,77.7,77.7,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,18.51,18.51,18.51,51,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,20.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,44.98,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,21.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,20.81,448,,facility
REPOSITION GASTROSTOMY TUBE,43761,CPT,361,RC,,,,outpatient,,,294.35,29.44,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,239.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,239.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,246.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,239.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,499.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,253.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,239.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,253.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2440,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,243.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,239.12,2440,,facility
PSYCH DIAGNOSTIC EVALUATION,90791,CPT,900,RC,,,,outpatient,,,189.89,18.99,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,140.97,140.97,169.87,145,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,169.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,169.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,174.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,169.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,355.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,180.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.56,11.56,11.56,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,169.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,180.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1372,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,173.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,169.87,1372,,professional
DRUG ASSAY CYCLOSPORINE,80158,CPT,301,RC,,,,outpatient,,,22.56,2.26,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,254.93,70.9,254.93,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,37.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.06,16.06,16.06,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.99,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.05,448,,facility
TX CLSD ELBOW DISLC W/O ANES,24600,CPT,761,RC,,,,outpatient,,,280.86,28.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,243.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,493.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,240.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,236.08,1173,,facility
INTMD RPR N-HF/GENIT >30.0CM,12047,CPT,450,RC,,,,outpatient,,,2171.91,217.19,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1974.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1974.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2033.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1974.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,4127.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2093.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1974.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2093.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2014.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,4127.08,,facility
CLTX GR HMRL TBRS FX W/MNPJ,23625,CPT,450,RC,,,,outpatient,,,1914.16,191.42,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1585.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3216.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1631.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1631.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1569.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3216.38,,facility
ASSAY OF FLUORIDE,82735,CPT,301,RC,,,,outpatient,,,23.18,2.32,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,40.06,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.54,448,,facility
ANTINOMYCES ANTIBODY,86602,CPT,302,RC,,,,outpatient,,,12.73,1.27,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,21.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.98,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,10.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,10.18,448,,facility
REMOVE FOREIGN BODY FROM EYE,65205,CPT,761,RC,,,,outpatient,,,152.14,15.21,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,131.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,266.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,134.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,134.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,129.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,127.33,448,,facility
CLOSTRIDIUM AG IA,87324,CPT,306,RC,,,,outpatient,,,14.98,1.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.9,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.98,448,,facility
GJB2 GENE KNOWN FAM VARIANTS,81253,CPT,310,RC,,,,outpatient,,,76.9,7.69,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,61.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,61.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,63.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,61.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,128.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,65.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,61.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,65.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,107.66,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,62.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,61.52,448,,facility
LEISHMANIA ANTIBODY,86717,CPT,302,RC,,,,outpatient,,,15.31,1.53,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.9,10.9,10.9,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.46,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.25,448,,facility
HHV-6 DNA AMP PROBE,87532,CPT,306,RC,,,,outpatient,,,43.86,4.39,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
SIMPLE CYSTOMETROGRAM,51725,CPT,761,RC,,,,outpatient,,,294.35,29.44,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,239.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,239.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,246.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,239.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,499.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,253.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,239.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,253.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,243.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,239.12,1173,,facility
BIOPSY OF FLOOR OF MOUTH,41108,CPT,761,RC,,,,outpatient,,,1930.94,193.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1628.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3303.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1675.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1675.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,1612.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3303.62,,facility
ASSAY OF HAPTOGLOBIN QUANT,83010,CPT,301,RC,,,,outpatient,,,15.73,1.57,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.19,11.19,11.19,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,143.09,143.09,143.09,21,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,31.92,31.92,91.06,1 through 10,percent of total billed charges,,,34.6,,98.37,98.37,98.37,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,26.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,56.91,56.91,56.91,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.19,11.19,11.19,23,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.18,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.58,448,,facility
DRAINAGE MOUTH ROOF LESION,42000,CPT,450,RC,,,,outpatient,,,290.91,29.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,226.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,226.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,233.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,226.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,473.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,240.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,226.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,240.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,231.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,226.68,1311,,facility
SMALL BOWEL ENDOSCOPY BR/WA,44380,CPT,750,RC,,,,outpatient,,,1079.61,107.96,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,868.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,868.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,894.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,868.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1814.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,920.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,868.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,920.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3821,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,885.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3821,,facility
MYCOBACTERIA DNA AMP PROBE,87551,CPT,306,RC,,,,outpatient,,,60.3,6.03,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,48.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,48.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,49.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,48.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,100.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,51.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,48.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,51.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,84.42,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,49.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,48.24,448,,facility
VASCULAR STUDY,93975,CPT,921,RC,,,,outpatient,,,291.84,29.18,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,212.09,212.09,229.93,90,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,2397.44,2397.44,2397.44,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,2210.14,2210.14,2210.14,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,235.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,1258.66,1258.66,1977.89,1 through 10,percent of total billed charges,,,33.6,,1258.66,1258.66,1977.89,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,1258.66,1258.66,1269.89,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,477.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,242.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,1873,1873,1873,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,166.94,166.94,175.13,87,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,242.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1227,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,232.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,228.36,1227,,facility
"INJ., KANJINTI, 10 MG",Q5117,HCPCS,636,RC,,,,outpatient,,,24.17,2.42,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,6879.99,6879.99,6879.99,39,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,60.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,60.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,62.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,60.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,126.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,64.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,60.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,64.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,74.58,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,61.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,60.52,448,,facility
GARDNER VAG DNA DIR PROBE,87510,CPT,306,RC,,,,outpatient,,,25.06,2.51,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,20.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,41.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,21.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,20.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,21.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,43.33,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,20.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,20.05,448,,facility
HEMOGLOBIN FETAL,85461,CPT,305,RC,,,,outpatient,,,11.7,1.17,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,9.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,19.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,9.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,9.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,9.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.38,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,9.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,9.36,448,,facility
ASSAY OF SILICA,84285,CPT,301,RC,,,,outpatient,,,31.51,3.15,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,25.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,52.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,26.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,25.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,26.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,50.86,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,25.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,25.21,448,,facility
G6PD KNOWN FAMILIAL VARIANT,81248,CPT,310,RC,,,,outpatient,,,469.06,46.91,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,375.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,375.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,386.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,375.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,784.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,397.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,375.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,397.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,656.69,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,382.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,375.25,784.27,,facility
"INJ, FULVESTRANT (FRESENIUS)",J9394,HCPCS,636,RC,,,,outpatient,,,15.32,1.53,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,27.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,27.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,56.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,28.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,27.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,28.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.36,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,27.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,26.36,448,,facility
UNLISTED MOLECULAR PATHOLOGY,81479,CPT,310,RC,,,,outpatient,,,1050,105,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,561.56,561.56,561.56,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,32.5,32.5,3071.5,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
STR MARKERS SPEC ANAL ADDL,81266,CPT,310,RC,,,,outpatient,,,400,40,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,304.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,304.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,313.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,304.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,637.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,323.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,304.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,323.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,533.42,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,310.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,304.81,637.05,,facility
DETECT AGENT NOS DNA AMP,87798,CPT,306,RC,,,,outpatient,,,520,52,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,110.88,110.88,174.24,1 through 10,percent of total billed charges,,,33.6,,244.27,244.27,244.27,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,96.77,32.38,119.79,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,38.9,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
PLACEMENT OF TUBE OF KIDNEY USING IMAGING GUIDANCE WITH REVIEW BY RADIOLOGIST,50432,CPT,0361,RC,,,,outpatient,,,5739,573.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,2000.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2000.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2060.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2000.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,4181.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2120.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2000.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2120.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9389,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,2040.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,9389,,facility
TEST TO DETERMINE LUNG VOLUMES USING SENSORS,94726,CPT,0460,RC,,,,outpatient,,,841,84.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,329.42,273.22,357.13,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,538.24,49.05,538.24,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,357.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,357.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,367.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,444.05,282.58,444.05,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,282.58,282.58,282.58,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,357.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,746.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,378.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,176.61,176.61,176.61,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,36.38,36.38,36.89,40,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,357.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,378.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,611,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,364.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,357.13,746.4,,facility
COLLAGEN CROSSLINKS,82523,CPT,301,RC,,,,outpatient,,,274,27.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,39.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.62,16.62,16.62,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,40.37,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.68,448,,facility
QUANTITATIVE ASSAY DRUG,80299,CPT,301,RC,,,,outpatient,,,157,15.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,13,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,174.64,174.64,174.64,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,171.6,171.6,171.6,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,374.52,374.52,374.52,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.62,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.64,448,,facility
COLLAGEN CROSS LINKS TEST; (URINE TEST TO EVALUATE BONE HEALTH),82523,CPT,0301,RC,,,,outpatient,,,76.9,7.69,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,39.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.62,16.62,16.62,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,40.37,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.68,448,,facility
COMPLEX CONTROL OF NOSE BLEED,30903,CPT,0456,RC,,,,outpatient,,,725,72.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,131.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,266.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,134.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,134.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,405,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,129.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,127.33,1173,,facility
CARBAMAZEPINE LEVEL; TOTAL,80156,CPT,0301,RC,,,,outpatient,,,140.25,14.03,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,47.04,47.04,47.04,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,30.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.96,12.96,12.96,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,31.47,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.57,448,,facility
RICKETTSIA ANTIBODY,86757,CPT,302,RC,,,,outpatient,,,161,16.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,17.21,17.21,17.21,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,40.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,20.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,17.21,17.21,17.21,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,20.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,41.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,19.35,448,,facility
BENZODIAZEPINES 13 OR MORE,80347,CPT,301,RC,,,,outpatient,,,433,43.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
X-RAY OF KNEE; 3 VIEWS,73562,CPT,0320,RC,,,,outpatient,,,1113,111.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,85.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,174.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,25.61,25.61,26.63,56,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,84.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,83.29,448,,facility
DESTRUCT PREMALG LES 2-14,17003,CPT,510,RC,,,,outpatient,,,79,7.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,1.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,1.63,1173,,facility
SARSCOV2&INF A&B&RSV AMP PRB,87637,CPT,306,RC,,,,outpatient,,,149,14.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,126.87,126.87,126.87,915,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,142.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,142.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,146.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,185,108.86,185.01,29,percent of total billed charges,,,33.6,,108.86,108.86,185.01,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,108.86,108.86,108.86,17,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,142.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,298.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,151.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,68.04,68.04,68.04,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,126.87,126.87,126.87,793,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,142.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,151.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,249.55,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,145.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,142.63,448,,facility
HEMOGLOBIN GLYCOSYLATED A1C,83036,CPT,301,RC,,,,outpatient,,,7.3,0.73,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,8.64,8.64,8.64,577,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,34.22,33.93,128.62,24,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,30.62,19.49,115.1,181,percent of total billed charges,,,33.6,,19.49,19.49,73.25,32,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,19.49,19.49,19.49,332,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,9.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,20.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,29,28.75,29,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,12.18,12.08,45.78,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,8.64,8.64,8.64,1 through 10,percent of total billed charges,,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,8.64,8.64,8.64,1281,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,9.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.98,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,9.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,9.71,448,,facility
CLOT FACTOR VIII VW ANTIGEN,85246,CPT,305,RC,,,,outpatient,,,28.68,2.87,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,20.4,20.4,20.4,44,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,23.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,71.28,45.36,71.28,1 through 10,percent of total billed charges,,,33.6,,45.36,45.36,45.36,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,45.77,45.36,45.77,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,47.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,24.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,67.5,67.5,67.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,20.4,20.4,20.4,74,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,24.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,49.56,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,23.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,22.94,448,,facility
IMMUNOASSAY QUANT NOS NONAB,83520,CPT,301,RC,,,,outpatient,,,257,25.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,36,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,66.08,66.08,66.08,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,41.18,24.82,318.38,1 through 10,percent of total billed charges,,,33.6,,37.63,37.63,96.43,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,33.6,23.18,176.4,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,36.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,87,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.22,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.27,448,,facility
COLLJ CAPILLARY BLOOD SPEC,36416,CPT,300,RC,,,,outpatient,,,6,0.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,63.36,63.36,63.36,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,40.32,40.32,40.32,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,50,,8,8,60,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,20.96,20.96,20.96,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.04,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",5.04,448,,facility
CLOT FACTOR XI PTA,85270,CPT,305,RC,,,,outpatient,,,85.5,8.55,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.92,15.92,15.92,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,37.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.92,15.92,15.92,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.68,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.9,448,,facility
ASSAY OF ADP & AMP,82030,CPT,301,RC,,,,outpatient,,,150,15,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,25.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,53.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,27.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,25.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,27.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,55.74,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,26.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,25.8,448,,facility
VIRUS INOCULATION SHELL VIA,87254,CPT,306,RC,,,,outpatient,,,102,10.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,40.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,20.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,20.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.26,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,19.56,448,,facility
ALPHA-1-ANTITRYPSIN TOTAL,82103,CPT,301,RC,,,,outpatient,,,131,13.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.95,11.95,11.95,14,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,15.79,11.42,30.1,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,19.15,11.42,48.05,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,28.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.95,11.95,11.95,58,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.03,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.44,448,,facility
FLUORESCENT ANTIBODY TITER,86256,CPT,302,RC,,,,outpatient,,,160,16,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.72,10.72,10.72,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.04,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.05,448,,facility
SO/HL 51/>GSAP RNA ALYS,81456,CPT,310,RC,,,,outpatient,,,3649.5,364.95,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2919.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2919.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3007.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2919.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,6101.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3094.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2919.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3094.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5109.3,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,2977.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,6101.96,,facility
UPPR GI SCOPE W/SUBMUC INJ,43236,CPT,750,RC,,,,outpatient,,,1079.61,107.96,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,800.68,800.68,800.68,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,868.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,868.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,894.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,868.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1814.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,920.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,868.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,920.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3821,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,885.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3821,,facility
MLH1 GENE FULL SEQ,81292,CPT,310,RC,,,,outpatient,,,420,42,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,675.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,675.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,695.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,675.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1411.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,715.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,675.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,715.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1181.95,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,688.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1411.59,,facility
IMMUNOASSAY QUANT NOS NONAB,83520,CPT,301,RC,,,,outpatient,,,81,8.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,36,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,66.08,66.08,66.08,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,41.18,24.82,318.38,1 through 10,percent of total billed charges,,,33.6,,37.63,37.63,96.43,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,33.6,23.18,176.4,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,36.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,87,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.22,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.27,448,,facility
DRUG SCRN QUAN LEVETIRACETAM,80177,CPT,301,RC,,,,outpatient,,,35.6,3.56,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.79,11.79,11.79,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,32.21,32.21,32.21,1 through 10,percent of total billed charges,,,33.6,,75.94,20.5,129.05,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,30.3,30.3,30.3,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.79,11.79,11.79,13,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.63,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.25,448,,facility
INSERT CATH PLEURA W/ IMAGE,32557,CPT,360,RC,,,,outpatient,,,1907.41,190.74,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,1506.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1506.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1551.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1506.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3148.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1596.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1506.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1596.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2712,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1536.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3148.69,,facility
IMMUNOASSAY QUANT NOS NONAB,83520,CPT,301,RC,,,,outpatient,,,69,6.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,36,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,66.08,66.08,66.08,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,41.18,24.82,318.38,1 through 10,percent of total billed charges,,,33.6,,37.63,37.63,96.43,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,33.6,23.18,176.4,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,36.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,87,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.22,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.27,448,,facility
BLD TYPING SEROLOGIC RH PHNT,86906,CPT,305,RC,,,,outpatient,,,47.76,4.78,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,74.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.75,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,36.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,16.75,448,,facility
DRUG ASSAY CLOZAPINE,80159,CPT,301,RC,,,,outpatient,,,52.75,5.28,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,20.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,42.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,21.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,20.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,21.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,39.95,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,20.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,20.15,448,,facility
IMMUNOASSAY NONANTIBODY,83516,CPT,301,RC,,,,outpatient,,,380,38,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9,9,10.26,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,4.75,4.75,218.59,30,percent of total billed charges,,,33.6,,3.02,3.02,175.39,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,3.02,3.02,211.68,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,24.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,23.5,23.5,23.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9,9,10.26,51,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.92,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,11.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.53,448,,facility
THER/PROPH/DIAG INJ IA,96373,CPT,260,RC,,,,outpatient,,,255.28,25.53,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,203.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,203.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,209.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,203.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,425.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,215.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,203.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,215.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,427,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,207.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,203.57,448,,facility
PROTOZOA ANTIBODY NOS,86753,CPT,302,RC,,,,outpatient,,,60,6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.02,11.02,11.02,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,98.11,98.11,154.18,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,96.77,32.38,106,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.02,11.02,11.02,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.76,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.39,448,,facility
3D RENDER W/INTRP POSTPROCES,76376,CPT,350,RC,,,,outpatient,,,2017,201.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,403,,,,,,,case rate,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,371,,,,,,,case rate,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,875,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1050,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,9.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,9.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,18.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,9.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,9.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,9.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1522,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,9.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,9.03,1522,,facility
HEMOGLOBIN UNSTABLE SCREEN,83068,CPT,301,RC,,,,outpatient,,,100,10,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,9.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,19.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,9.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.29,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,9.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,9.47,448,,facility
CT SCAN OF ARM WITHOUT CONTRAST,73200,CPT,0352,RC,,,,outpatient,,,3110,311,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,403,,,,,,,case rate,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,371,,,,,,,case rate,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,875,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1050,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,85.12,85.12,85.12,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1522,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,1522,,facility
HIV-1 QUANT&REVRSE TRNSCRPJ,87536,CPT,306,RC,,,,outpatient,,,1352,135.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,75.7,75.7,75.7,61,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,115.05,115.05,369.93,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,124.8,124.8,124.8,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,85.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,85.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,87.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,102.96,65.52,102.96,24,percent of total billed charges,,,33.6,,102.96,65.52,331.06,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,65.52,65.52,66.11,15,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,85.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,177.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,90.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,97.5,97.5,97.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,75.7,75.7,75.7,201,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,85.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,90.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,183.86,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,86.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,85.1,448,,facility
MEASUREMENT C-REACTIVE PROTEIN FOR DETECTION OF INFECTION OR INFLAMMATION; HIGH SENSITIVITY,86141,CPT,0302,RC,,,,outpatient,,,66.5,6.65,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.52,11.52,11.52,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,35.38,35.38,35.38,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,22.51,22.51,22.54,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.52,11.52,11.52,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.97,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.95,448,,facility
HEMOGLOBIN ANALYSIS AND MEASUREMENT; ELECTROPHORESIS,83020,CPT,0301,RC,,,,outpatient,,,36.25,3.63,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.45,11.45,11.45,22,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,12.1,12.1,12.29,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,26.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,18,18,18,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,29.19,29.19,29.19,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.45,11.45,11.45,47,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.81,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.87,448,,facility
TREAT FOOT DISLOCATION,28570,CPT,450,RC,,,,outpatient,,,280.86,28.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,243.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,493.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,240.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,236.08,1173,,facility
CLOT FACTOR VIII MULTIMETRIC,85247,CPT,305,RC,,,,outpatient,,,28.68,2.87,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,23.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,47.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,24.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,20.4,20.4,20.4,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,24.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,49.56,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,23.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,22.94,448,,facility
CATHETERIZE FOR URINE SPEC,P9612,HCPCS,300,RC,,,,outpatient,,,11.04,1.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,9.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,19.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,9.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,9.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,9.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.25,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,9.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.25,1173,,facility
BLOOD TEST; LIPIDS (CHOLESTEROL AND TRIGLYCERIDES),80061,CPT,0301,RC,,,,outpatient,,,247,24.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.91,11.91,11.91,1021,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,34.81,34.81,34.81,26,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,37.76,37.76,37.76,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,31.15,19.82,31.15,172,percent of total billed charges,,,33.6,,20,19.82,31.15,37,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,19.82,19.82,20,389,percent of total billed charges,,,34.6,,21.83,21.83,21.83,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,29.5,29.5,123.5,11,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,12.39,12.39,51.87,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.91,11.91,11.91,1133,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.93,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.39,448,,facility
PROTOZOA ANTIBODY NOS,86753,CPT,302,RC,,,,outpatient,,,85,8.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.02,11.02,11.02,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,98.11,98.11,154.18,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,96.77,32.38,106,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.02,11.02,11.02,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.76,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.39,448,,facility
ASSAY OF DIGOXIN TOTAL,80162,CPT,301,RC,,,,outpatient,,,16.6,1.66,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.68,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.28,448,,facility
IRRIGATION OF IMPLANTED VENOUS ACCESS DRUG DELIVERY DEVICE,96523,CPT,0260,RC,,,,outpatient,,,218,21.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,52.12,52.08,56.46,62,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,152.96,141.01,152.96,35,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,79.1,79.1,79.1,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,56.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,56.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,58.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,126.19,80.3,126.19,1 through 10,percent of total billed charges,,,33.6,,80.3,80.3,80.3,14,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,80.3,73.9,80.3,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,56.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,118,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,59.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,29.94,29.94,29.94,59,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,56.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,59.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,427,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,57.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,56.46,448,,facility
CUSTOM SHAPE COVER AK,L5705,HCPCS,274,RC,,,,outpatient,,,1725,172.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,66,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,61,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1172.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1172.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1207.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1172.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,2450.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1242.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1172.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1242.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,1195.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,1172.4,2450.32,,facility
REPAIR MOUTH LACERATION,40830,CPT,450,RC,,,,outpatient,,,290.91,29.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,203.75,203.75,209.09,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,226.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,226.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,233.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,427.11,427.11,427.11,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,226.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,473.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,240.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,226.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,240.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,231.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,226.68,473.76,,facility
DNA/RNA AMPLIFIED PROBE,87150,CPT,306,RC,,,,outpatient,,,721,72.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
ASSAY OF IRON,83540,CPT,301,RC,,,,outpatient,,,147,14.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.75,5.75,5.75,336,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,19.18,19.18,60.77,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,17.42,11.09,54.38,99,percent of total billed charges,,,33.6,,11.09,11.09,54.38,18,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,11.09,11.02,34.61,116,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,13.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,16.5,16.5,16.5,11,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.75,5.75,5.75,876,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.98,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,6.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,6.47,448,,facility
TOT CONTACT AK/KNEE DISART S,L5650,HCPCS,274,RC,,,,outpatient,,,1042,104.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,66,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,61,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,701.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,701.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,722.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,701.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1465.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,743.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,701.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,743.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,715.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,701.34,1465.8,,facility
FOOT ARCH SUPP LONGITUD/META,L3060,HCPCS,274,RC,,,,outpatient,,,137,13.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,66,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,61,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,91.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,91.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,93.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,91.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,190.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,96.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,91.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,96.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,92.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,91.13,190.46,,facility
US LMTD JT/FCL EVL NVASC XTR,76882,CPT,402,RC,,,,outpatient,,,130.94,13.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,617.6,617.6,617.6,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,508.99,508.99,509.52,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,324.24,324.24,324.24,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,25.61,25.61,25.8,25,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,465,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,465,,facility
X-RAY EXAM CHEST 3 VIEWS,71047,CPT,324,RC,,,,outpatient,,,108.23,10.82,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,85.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,174.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,84.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,83.29,448,,facility
CHIMERISM ANAL W/CELL SELECT,81268,CPT,310,RC,,,,outpatient,,,325.99,32.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,231.97,231.97,231.97,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,2152.96,2152.96,2152.96,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,260.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,260.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,268.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,653.4,653.4,685.8,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,1130.3,495.96,1221.13,22,percent of total billed charges,,,34.6,,1221.13,1221.13,2354.8,12,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,260.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,545.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,276.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,231.97,231.97,231.97,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,260.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,276.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,563.43,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,266.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,260.79,563.43,,facility
CHORIONIC GONADOTROPIN TEST,84702,CPT,301,RC,,,,outpatient,,,61,6.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.39,13.39,13.39,99,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,35.99,35.99,146.32,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,32.21,32.21,141.61,16,percent of total billed charges,,,33.6,,32.21,20.5,83.33,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,20.5,20.5,83.33,45,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,31.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,12.81,12.81,12.81,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,13.39,13.39,13.39,1 through 10,percent of total billed charges,,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.39,13.39,13.39,208,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.53,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,15.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,15.05,448,,facility
COAGULATION TIME ACTIVATED,85347,CPT,305,RC,,,,outpatient,,,33,3.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,57.12,38.17,224.4,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,8.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.81,3.81,3.81,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.21,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,4.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,4.28,448,,facility
EXT ECG>48HR<7D SCAN A/R,93243,CPT,730,RC,,,,outpatient,,,152.14,15.21,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,131.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,266.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,134.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,134.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,389,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,129.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,127.33,448,,facility
APHERESIS WBC,36511,CPT,940,RC,,,,outpatient,,,1827.36,182.74,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1490.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1490.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1535.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1490.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3115.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1579.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1490.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1579.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,418,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1520.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,418,3115.25,,facility
OCCULT BLOOD OTHER SOURCES,82271,CPT,301,RC,,,,outpatient,,,6.65,0.67,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,11.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.73,4.73,4.73,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.31,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.32,448,,facility
ASSAY OF VITAMIN B-2,84252,CPT,301,RC,,,,outpatient,,,25.3,2.53,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,18,18,18,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,20.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,42.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,21.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,20.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,21.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,43.72,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,20.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,20.24,448,,facility
ASSAY OF URINE CREATININE,82570,CPT,301,RC,,,,outpatient,,,60,6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.61,4.61,4.61,213,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,71.39,41.89,142.78,14,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,37.49,23.86,74.98,60,percent of total billed charges,,,33.6,,37.49,23.85,81.31,18,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,24.07,23.86,47.71,75,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,10.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,60.5,4.61,151,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,14.91,14.91,25.41,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,85.58,85.58,85.58,1 through 10,percent of total billed charges,,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.61,4.61,4.61,636,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.18,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.18,448,,facility
INTERMEDIATE REPAIR OF WOUND OF SCALP; UNDERARMS; TRUNK; ARMS; OR LEGS; 2.6-7.5 CM,12032,CPT,0450,RC,,,,outpatient,,,1108,110.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,350.55,328.18,350.55,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,400.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,483.84,483.84,483.84,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,813.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,412.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,355.79,355.79,366.07,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,412.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,396.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,389.05,1173,,facility
DRUG SCREEN QUANTALCOHOLS,80320,CPT,301,RC,,,,outpatient,,,228,22.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
TREATMENT OF ANKLE FRACTURE,27786,CPT,761,RC,,,,outpatient,,,280.86,28.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,243.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,493.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,240.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,236.08,1173,,facility
IMMUNOASSAY INFECTIOUS AGENT,86317,CPT,302,RC,,,,outpatient,,,236,23.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.33,13.33,13.33,86,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,59,59,59,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,52.8,26.54,52.8,41,percent of total billed charges,,,33.6,,52.8,33.6,52.8,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,33.6,33.6,33.73,52,percent of total billed charges,,,34.6,,218.53,218.53,218.53,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,31.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,50,50,50,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.33,13.33,13.33,209,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.38,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,15.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.99,448,,facility
ASSAY OF VIP,84586,CPT,301,RC,,,,outpatient,,,44.16,4.42,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,191.66,191.66,191.66,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,76.34,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,36.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.33,448,,facility
HSV DNA QUANT,87530,CPT,306,RC,,,,outpatient,,,53.55,5.36,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,44.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,89.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,45.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,42.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,45.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,92.54,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,43.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,42.84,448,,facility
BABESIA MICROTI AMP PRB,87469,CPT,306,RC,,,,outpatient,,,43.86,4.39,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,61.41,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
CELL FUNCTION ASSAY W/STIM,86352,CPT,302,RC,,,,outpatient,,,600,60,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,135.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,135.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,139.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,210.52,210.52,210.52,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,135.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,283.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,144.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,120.85,120.85,120.85,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,135.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,144.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,293.53,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,138.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,135.86,448,,facility
CYTOGENOMIC NEO MICRORA ALYS,81277,CPT,310,RC,,,,outpatient,,,1450,145,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1160,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1160,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1194.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,3279.09,3279.09,3279.09,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1160,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,2424.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1229.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,975.94,975.94,1031.8,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1160,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1229.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2030,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1183.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,2424.4,,facility
X-RAY EXAM OF JAW <4VIEWS,70100,CPT,320,RC,,,,outpatient,,,108.23,10.82,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,85.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,174.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,84.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,83.29,448,,facility
REPOSITION PACING-DEFIB LEAD,33215,CPT,361,RC,,,,outpatient,,,3796.26,379.63,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1027,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1519,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,3021.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3021.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3112.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3021.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,6315.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3203.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3021.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3203.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10137,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,3082.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,10137,,facility
SRS MULTISOURCE,77371,CPT,333,RC,,,,outpatient,,,9274.55,927.46,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,6279.27,6279.27,6707.31,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7049.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7049.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7260.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,7049.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,14732.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,7471.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,7049.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,7471.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,48815,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,7189.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,48815,,facility
DRUG TEST PRSMV CHEM ANLYZR,80307,CPT,301,RC,,,,outpatient,,,333,33.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,55.27,55.27,55.27,34,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,62.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,62.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,171.87,131.38,223.26,14,percent of total billed charges,,,33.6,,206.45,131.38,223.26,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,131.38,102.04,131.38,13,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,62.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,129.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,65.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,55.27,55.27,55.27,332,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,62.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,65.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,125.7,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,63.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,62.14,448,,facility
ASSAY OF ADP & AMP,82030,CPT,301,RC,,,,outpatient,,,32.25,3.23,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,25.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,53.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,27.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,25.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,27.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,55.74,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,26.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,25.8,448,,facility
SPLIT BLOOD OR PRODUCTS,86985,CPT,390,RC,,,,outpatient,,,203.43,20.34,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,167.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,340.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,172.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,172.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,226.07,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,166.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,163.06,448,,facility
IMMUNOASSAY QUANT NOS NONAB,83520,CPT,301,RC,,,,outpatient,,,94,9.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,36,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,66.08,66.08,66.08,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,41.18,24.82,318.38,1 through 10,percent of total billed charges,,,33.6,,37.63,37.63,96.43,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,33.6,23.18,176.4,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,36.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,87,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.22,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.27,448,,facility
ANCA TITER EACH ANTIBODY,86037,CPT,302,RC,,,,outpatient,,,15.06,1.51,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,85.68,85.68,85.68,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,75.26,75.26,75.26,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.09,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.05,448,,facility
HIV-1/HIV-2 1 RESULT ANTBDY,86703,CPT,302,RC,,,,outpatient,,,17.14,1.71,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,28.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.61,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.71,448,,facility
LYME DISEASE ANTIBODY,86618,CPT,302,RC,,,,outpatient,,,417,41.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,35.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.15,15.15,15.15,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.79,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.03,448,,facility
CHLMYD TRACH DNA AMP PROBE,87491,CPT,306,RC,,,,outpatient,,,1597,159.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,442,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,20.65,20.65,65.49,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,232.32,232.32,232.32,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,37.3,18.48,58.61,62,percent of total billed charges,,,33.6,,37.3,11.76,63.38,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,28.82,11.76,37.3,69,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,42.5,17.5,55.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,23.31,23.31,23.31,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,31.21,31.21,31.21,1 through 10,percent of total billed charges,,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,796,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
MULTI-AXIAL KNEE/SHIN SYSTEM,L5840,HCPCS,274,RC,,,,outpatient,,,6314,631.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,66,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,61,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Stoploss First Dollar + Reimbursement Rate 50.00 + Percent Of Charge + Reimbursement Rate 0.00 + Fixed Amount 3149.00,,,,0,other,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,Stoploss First Dollar + Reimbursement Rate 50.00 + Percent Of Charge + Reimbursement Rate 0.00 + Fixed Amount 3149.00,,,,0,other,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,4294.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4294.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4423.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4294.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,8976.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4552.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4294.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4552.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,4380.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,4294.9,8976.34,,facility
QUANTITATIVE ASSAY DRUG,80299,CPT,301,RC,,,,outpatient,,,599,59.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,13,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,174.64,174.64,174.64,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,171.6,171.6,171.6,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,374.52,374.52,374.52,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.62,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.64,448,,facility
VIRAL NEUTRALIZATION TEST TO DETECT VIRAL ANTIBODY LEVEL,86382,CPT,0302,RC,,,,outpatient,,,680,68,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,493.68,493.68,493.68,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,35.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.54,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,16.91,448,,facility
CHEMILUMINESCENT ASSAY,82397,CPT,301,RC,,,,outpatient,,,68,6.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.56,12.56,12.56,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,22.85,22.85,22.85,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,29.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.56,12.56,12.56,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.5,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.12,448,,facility
IMMUNOASSAY QUANT NOS NONAB,83520,CPT,301,RC,,,,outpatient,,,1351,135.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,36,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,66.08,66.08,66.08,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,41.18,24.82,318.38,1 through 10,percent of total billed charges,,,33.6,,37.63,37.63,96.43,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,33.6,23.18,176.4,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,36.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,87,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.22,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.27,448,,facility
X-RAY OF SKULL; MINIMUM OF 4 VIEWS,70260,CPT,0320,RC,,,,outpatient,,,1507,150.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,448,,facility
DNA/RNA AMPLIFIED PROBE,87150,CPT,306,RC,,,,outpatient,,,204,20.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
REVIEW BY RADIOLOGIST OF IMAGE FOR REMOVAL OF OBSTRUCTIVE MATERIAL,75901,CPT,0320,RC,,,,outpatient,,,917,91.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,21.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,45.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,21.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,21.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,21.55,448,,facility
DRUGS UNCLASSIFIED INJECTION,J3490,HCPCS,636,RC,,,,outpatient,,,21,2.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,2.56,2.56,292.8,17,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,52.8,,6,2.11,205.42,49,percent of total billed charges,,,33.6,,6.72,0.67,163.37,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,5.29,0.84,200.34,25,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,50,,1,1,9.13,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,7.61,7.61,7.61,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",448,448,,facility
NUCLEAR ANTIGEN ANTIBODY,86235,CPT,302,RC,,,,outpatient,,,236,23.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13,12.5,15.95,11,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,54.91,4.37,90.29,43,percent of total billed charges,,,33.6,,4.37,4.37,53.09,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,22.18,4.24,83.33,13,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,37.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.95,13,15.95,54,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.75,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.93,448,,facility
CYTOGENETICS DNA PROBE,88271,CPT,311,RC,,,,outpatient,,,664,66.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.05,19.05,19.05,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,1274.11,1274.11,1274.11,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,477.79,477.79,477.79,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,21.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,44.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.05,19.05,19.05,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,21.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,46.27,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,21.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,21.42,448,,facility
CULTURE TYPE IMMUNOLOGIC,87147,CPT,306,RC,,,,outpatient,,,37,3.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.61,4.61,4.61,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,69.03,69.03,69.03,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,57.55,36.95,66.81,12,percent of total billed charges,,,33.6,,39.31,39.31,39.31,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,39.31,39.31,39.31,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,10.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,58.5,58.5,58.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.61,4.61,4.61,65,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.18,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.18,448,,facility
CYTOGENETICS DNA PROBE,88271,CPT,311,RC,,,,outpatient,,,2199,219.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.05,19.05,19.05,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,1274.11,1274.11,1274.11,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,477.79,477.79,477.79,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,21.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,44.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.05,19.05,19.05,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,21.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,46.27,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,21.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,21.42,448,,facility
TARGETED GENOMIC SEQUENCE ANALYSIS PANEL; SOLID ORGAN OR HEMATOLYMPHOID NEOPLASM OR DISORDER; 51 OR GREATER GENES (EG; ALK; BRAF; CDKN2A; CEBPA; DNMT3A; EGFR; ERBB2; EZH2; FLT3; IDH1; IDH2; JAK2; KIT; KRAS; MET; MLL; NOTCH1; NPM1; NRAS; PDGFRA; PDGFRB; PGR; PIK3CA; PTEN; RET); INTERROGATION FOR SEQUENCE VARIANTS AND COPY NUMBER VARIANTS OR REARRANGEMENTS; OR ISOFORM EXPRESSION OR MRNA EXPRESSION LEVELS; IF PERFORMED; RNA ANALYSIS,81456,CPT,0310,RC,,,,outpatient,,,7245,724.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2919.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2919.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3007.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2919.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,6101.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3094.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2919.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3094.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5109.3,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,2977.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,6101.96,,facility
ANALYSIS FOR ANTIBODY BORRELIA BURGDORFERI (LYME DISEASE BACTERIA),86618,CPT,0302,RC,,,,outpatient,,,37.25,3.73,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,35.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.15,15.15,15.15,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.79,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.03,448,,facility
HEMOGLOBIN CHROMOTOGRAPHY,83021,CPT,301,RC,,,,outpatient,,,223,22.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.06,16.06,16.06,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,37.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,58.38,58.38,58.38,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.06,16.06,16.06,16,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,39.01,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.06,448,,facility
EXOME SEQUENCE ANALYSIS,81416,CPT,310,RC,,,,outpatient,,,3505,350.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12000,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12000,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12360,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12000,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25080,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12720,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12000,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12720,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21000,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12240,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,25080,,facility
GAMMAGLOBULIN (IMMUNE SYSTEM PROTEIN) MEASUREMENT,82784,CPT,0301,RC,,,,outpatient,,,194,19.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,8.27,8.27,8.27,98,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,114.46,59,343.38,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,52.8,30.49,158.4,64,percent of total billed charges,,,33.6,,19.58,19.49,33.6,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,53.09,19.49,195.55,67,percent of total billed charges,,,34.6,,190.57,73.91,336.04,67,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,9.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,19.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,9.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,29,29,50,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,8.27,8.27,8.27,371,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,9.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,9.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.09,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,9.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,9.3,448,,facility
RENAL FUNCTION PANEL,80069,CPT,301,RC,,,,outpatient,,,55,5.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,7.72,7.72,7.72,44,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,32.45,7.72,32.45,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,29.04,18.48,254.93,17,percent of total billed charges,,,33.6,,18.48,18.48,18.48,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,18.48,18.48,252.67,27,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,18.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,9.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,27.5,27.5,27.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,7.72,7.72,7.72,276,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,9.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.76,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,8.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,8.68,448,,facility
ASSAY OF LEAD,83655,CPT,301,RC,,,,outpatient,,,218,21.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.77,10.77,10.77,70,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,47.79,47.79,47.79,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,27.22,27.22,42.77,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,11.76,11.76,27.22,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,40.5,40.5,40.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.77,10.77,10.77,84,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.16,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.11,448,,facility
MUCOPOLYSACCHARIDES (PROTEIN) LEVEL,83864,CPT,0301,RC,,,,outpatient,,,380,38,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,25.35,25.35,25.35,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,54.38,54.38,54.38,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,28.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,59.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,30.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,28.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,30.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,49.88,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,29.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,28.5,448,,facility
HEXAGNAL PHOSPH PLTLT NEUTRL,85598,CPT,305,RC,,,,outpatient,,,265,26.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.99,15.99,15.99,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,168.32,168.32,168.32,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,37.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.98,448,,facility
DRUG TEST PRSMV CHEM ANLYZR,80307,CPT,301,RC,,,,outpatient,,,675,67.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,55.27,55.27,55.27,34,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,62.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,62.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,171.87,131.38,223.26,14,percent of total billed charges,,,33.6,,206.45,131.38,223.26,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,131.38,102.04,131.38,13,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,62.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,129.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,65.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,55.27,55.27,55.27,332,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,62.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,65.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,125.7,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,63.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,62.14,448,,facility
DILATION OF STOMACH AND/OR SMALL BOWEL USING LONG GASTROINTESTINAL TUBE,44500,CPT,0761,RC,,,,outpatient,,,251,25.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,822.62,411.31,822.62,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,868.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,868.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,894.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,97.1,85.09,97.1,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,868.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1814.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,920.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,868.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,920.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,69.93,46.23,73.47,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,885.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1814.2,,facility
"INJ, TREMELIMUMAB-ACTL, 1 MG",J9347,HCPCS,636,RC,,,,outpatient,,,546,54.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,146.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,146.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,151.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,146.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,307,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,155.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,146.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,155.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,297.62,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,149.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,146.89,448,,facility
CT SCAN OF CRANIAL CAVITY WITHOUT CONTRAST,70480,CPT,0351,RC,,,,outpatient,,,6144,614.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,93.3,92.3,93.3,11,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,403,,,,,,,case rate,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,371,,,,,,,case rate,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,875,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1050,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,3244.03,3244.03,3508.22,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,3072,3072,3072,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,81.72,81.72,81.72,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1522,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,1522,,facility
ASSAY OF VITAMIN B-6,84207,CPT,301,RC,,,,outpatient,,,282,28.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,24.99,24.99,24.99,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,48.53,48.53,48.53,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,43.43,43.43,43.43,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,27.55,18.82,27.55,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,28.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,58.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,29.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,24.99,24.99,24.99,18,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,28.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,29.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,60.71,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,28.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,28.1,448,,facility
QUANTITATIVE ASSAY DRUG,80299,CPT,301,RC,,,,outpatient,,,189,18.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,13,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,174.64,174.64,174.64,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,171.6,171.6,171.6,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,374.52,374.52,374.52,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.62,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.64,448,,facility
REPAIR OF CENTRAL VENOUS TUBE FOR INFUSION,36575,CPT,0450,RC,,,,outpatient,,,1908,190.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,542.46,542.46,550.57,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,600.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,600.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,618.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,600.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1254.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,636.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,550.57,550.57,550.57,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,600.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,636.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,612.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1311,,facility
COL CHROMOTOGRAPHY QUAL/QUAN,82542,CPT,301,RC,,,,outpatient,,,869,86.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,21.43,21.43,21.43,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,435.07,435.07,435.07,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,24.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,50.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,25.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,21.43,21.43,21.43,15,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,24.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,25.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.16,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,24.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,24.09,448,,facility
SPECIAL RADIATION THERAPY PLANNING FOR DELIVERY OF EXTERNAL RADIATION,77321,CPT,0333,RC,,,,outpatient,,,2437,243.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,358.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,358.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,369.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,358.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,748.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,379.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,358.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,379.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,48815,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,365.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,358.36,48815,,facility
IMMUNOASSAY QUANT NOS NONAB,83520,CPT,301,RC,,,,outpatient,,,629,62.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,36,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,66.08,66.08,66.08,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,41.18,24.82,318.38,1 through 10,percent of total billed charges,,,33.6,,37.63,37.63,96.43,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,33.6,23.18,176.4,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,36.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,87,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.22,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.27,448,,facility
ALBUMIN (PROTEIN) LEVEL,82040,CPT,0301,RC,,,,outpatient,,,85,8.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.4,4.4,4.4,46,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,14.75,9.9,14.75,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,85,85,85,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,48.53,13.2,48.54,74,percent of total billed charges,,,33.6,,28.56,8.4,48.53,18,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,28.56,8.4,28.82,49,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,10.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,42.5,12.5,42.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,5.25,5.25,5.25,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.4,4.4,4.4,515,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.69,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,4.95,448,,facility
PROGRAMMING OF SINGLE LEAD PACEMAKER SYSTEM,93279,CPT,0480,RC,,,,outpatient,,,198,19.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,32.72,32.72,32.72,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,145.92,145.92,145.92,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,35.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,74.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1463,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,36.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.71,1463,,facility
ASSAY DIR MEAS FR ESTRADIOL,82681,CPT,301,RC,,,,outpatient,,,63,6.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,27.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,58.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,29.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,27.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,29.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,48.9,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,28.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,27.94,448,,facility
SPECTROPHOTOMETRY,84311,CPT,301,RC,,,,outpatient,,,331,33.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,7.2,7.2,7.2,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,45.35,45.35,53.33,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,16.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,7.2,7.2,7.2,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.1,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,8.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,8.1,448,,facility
VIRUS ANTIBODY NOS,86790,CPT,302,RC,,,,outpatient,,,340,34,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.46,11.46,11.46,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,107.86,20.06,169.49,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,116.52,40.29,122.3,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,26.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.46,11.46,11.46,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.88,448,,facility
UNLISTED MOLECULAR PATHOLOGY,81479,CPT,310,RC,,,,outpatient,,,1545,154.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,561.56,561.56,561.56,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,32.5,32.5,3071.5,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
CONTINUOUS MONITORING OF BLOOD SUGAR LEVEL IN TISSUE FLUID USING SENSOR UNDER SKIN,95249,CPT,0920,RC,,,,outpatient,,,206,20.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,52.12,52.12,52.12,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,56.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,56.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,58.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,56.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,118,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,59.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,56.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,59.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,422,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,57.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,56.46,448,,facility
TREPONEMA PALLIDUM,86780,CPT,302,RC,,,,outpatient,,,272,27.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.78,11.78,11.78,612,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,10.62,10.62,50.15,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,9.5,6.05,48.53,46,percent of total billed charges,,,33.6,,6.05,6.05,44.88,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,6.05,6.05,28.56,66,percent of total billed charges,,,34.6,,73.69,20.19,77.34,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,9,9,42.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,17.85,17.85,17.85,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,11.78,11.78,11.78,1 through 10,percent of total billed charges,,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.78,11.78,11.78,550,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.6,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.24,448,,facility
ETHOSUXIMIDE LEVEL,80168,CPT,0301,RC,,,,outpatient,,,72,7.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,34.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,14.53,14.53,14.53,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.3,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,16.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,16.34,448,,facility
LITHIUM LEVEL,80178,CPT,0301,RC,,,,outpatient,,,176,17.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.88,5.88,5.88,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,27.29,27.22,42.77,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,13.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,7.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.88,5.88,5.88,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,7.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.28,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,6.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,6.61,448,,facility
FIBRINOLYSINS SCREEN I&R,85390,CPT,305,RC,,,,outpatient,,,27,2.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.77,13.77,13.77,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,24.82,24.82,24.82,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,9.07,9.07,9.07,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,32.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.77,13.77,13.77,12,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.09,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,15.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,15.48,448,,facility
ASSAY OF NOS VITAMIN,84591,CPT,301,RC,,,,outpatient,,,325,32.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,35.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.86,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.06,448,,facility
EL-1 FECAL QUANTITATIVE,82653,CPT,301,RC,,,,outpatient,,,497,49.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,20.43,20.43,20.43,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,23.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,262.42,103.49,262.42,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,65.86,65.86,65.86,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,48.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,24.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,20.43,20.43,20.43,28,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,24.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,40.2,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,23.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,22.97,448,,facility
MOPATH PROCEDURE LEVEL 2,81401,CPT,310,RC,,,,outpatient,,,283,28.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,121.86,121.86,121.86,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,137,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,137,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,141.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,137,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,286.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,145.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,137,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,145.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,239.75,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,139.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,137,448,,facility
ANALYSIS FOR ANTIBODY TO FRANCISELLA TULARENSIS (BACTERIA TRANSMITTED BY RODENTS),86668,CPT,0302,RC,,,,outpatient,,,234,23.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.6,12.6,12.6,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,29.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.6,12.6,12.6,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.78,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.16,448,,facility
TEST SOCKET SYMES,L5618,HCPCS,274,RC,,,,outpatient,,,550,55,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,66,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,61,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,369.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,369.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,380.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,369.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,772.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,392.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,369.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,392.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,377.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,369.85,772.99,,facility
ANTIPSYCHOTICS NOS 1-3,80342,CPT,301,RC,,,,outpatient,,,433,43.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
CT SCAN OF BLOOD VESSELS OF ARM WITH CONTRAST,73206,CPT,0350,RC,,,,outpatient,,,5250,525,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,875,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1050,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,172.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,350.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,177.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,177.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1522,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,171.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,167.87,1522,,facility
PROTOZOA ANTIBODY NOS,86753,CPT,302,RC,,,,outpatient,,,343,34.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.02,11.02,11.02,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,98.11,98.11,154.18,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,96.77,32.38,106,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.02,11.02,11.02,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.76,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.39,448,,facility
"BRACHYTX, NON-STR, HA, I-125",C2634,HCPCS,278,RC,,,,outpatient,,,290,29,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,66,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,61,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,173.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,173.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,178.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,173.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,362.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,183.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,173.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,183.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,176.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,173.21,362.01,,facility
CONVERSION OF STOMACH TUBE TO STOMACH-TO-SMALL BOWEL TUBE USING FLUOROSCOPIC GUIDANCE WITH CONTRAST,49446,CPT,0750,RC,,,,outpatient,,,8934,893.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,1836.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1836.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1891.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1836.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3838.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1946.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1836.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1946.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3821,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1873.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3838.31,,facility
MOPATH PROCEDURE LEVEL 2,81401,CPT,301,RC,,,,outpatient,,,400,40,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,137,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,137,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,141.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,137,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,286.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,145.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,137,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,145.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,239.75,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,139.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,137,448,,facility
ENDO KNEE-SHIN FRCT SWG & ST,L5818,HCPCS,274,RC,,,,outpatient,,,1750,175,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,66,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,61,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1189.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1189.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1225.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1189.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,2486.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1261.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1189.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1261.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,1213.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,1189.74,2486.56,,facility
URINALYSIS VOLUME MEASURE,81050,CPT,307,RC,,,,outpatient,,,88,8.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.24,3.24,3.24,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,3.7,3.36,3.7,1 through 10,percent of total billed charges,,,33.6,,3.36,3.36,3.36,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,3.36,3.36,3.36,1 through 10,percent of total billed charges,,,34.6,,3.99,3.99,3.99,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,7.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.24,3.24,98.45,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.49,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,3.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,3.64,448,,facility
FURNSH INITIAL ORTHOSIS ONLY,L1200,HCPCS,274,RC,,,,outpatient,,,3072,307.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,66,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,61,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2070.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2070.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2132.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2070.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,4327.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2194.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2070.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2194.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,2112.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,2070.7,4327.76,,facility
CT GUIDANCE FOR INSERTION OF RADIATION THERAPY FIELDS,77014,CPT,0350,RC,,,,outpatient,,,3641,364.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,403,,,,,,,case rate,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,371,,,,,,,case rate,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,875,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1050,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,"Payer contract is 100.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 103.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment.",,,,0,other,"Payer contract is 103.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment. + No services performed during 15-month lookback period",,52.8,,1406.83,1406.83,1406.83,27,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,1406.83,1406.83,1406.83,13,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment. + No services performed during 15-month lookback period",,,"Payer contract is 209.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment.",,,,0,other,"Payer contract is 209.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment. + No services performed during 15-month lookback period",,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment. + No services performed during 15-month lookback period",,50,,2093.5,2093.5,2093.5,15,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment.",126.29,126.29,126.29,1 through 10,other,"Payer contract is 100.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment.",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1522,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,"Payer contract is 102.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment.",,,,0,other,"Payer contract is 102.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment. + No services performed during 15-month lookback period",371,1522,,facility
COAGULATION TIME MEASUREMENT; ACTIVATED,85347,CPT,0305,RC,,,,outpatient,,,85,8.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,57.12,38.17,224.4,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,8.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.81,3.81,3.81,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.21,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,4.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,4.28,448,,facility
AK/KNEE DISARTIC ACRYLIC SOC,L5631,HCPCS,274,RC,,,,outpatient,,,1065,106.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,66,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,61,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,717.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,717.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,738.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,717.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1498.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,760.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,717.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,760.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,731.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,717.21,1498.97,,facility
CLOSED TREATMENT OF DISLOCATED FOREARM BONE ON THUMB SIDE AT ELBOW WITH MANIPULATION; CHILD,24640,CPT,0450,RC,,,,outpatient,,,3201,320.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,243.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,493.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,240.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,236.08,493.41,,facility
RUBEOLA ANTIBODY,86765,CPT,302,RC,,,,outpatient,,,228,22.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.46,11.46,11.46,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,22.18,22.18,83.95,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,20.68,20.68,20.68,1 through 10,percent of total billed charges,,,34.6,,61.35,61.35,61.35,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,26.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,44,44,44,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.46,11.46,11.46,18,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.88,448,,facility
REMOVAL OF POLYPS OR GROWTHS OF LARGE BOWEL USING AN ENDOSCOPE WITH MECHANICAL SNARE,45385,CPT,0750,RC,,,,outpatient,,,4873,487.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,1034.53,517.26,1077.58,18,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,458,458,458,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1179.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,2187.98,2073.12,2770.33,11,percent of total billed charges,,,33.6,,2770.33,2073.12,8977.08,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,2073.12,2073.12,2073.12,17,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,2393.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1213.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,3085,3085,3085,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,1295.7,1295.7,1295.7,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,1049.99,1049.99,1077.58,11,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1213.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3821,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1168.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3821,,facility
TEST TO MEASURE THE TOTAL VOLUME OF AIR THAT CAN BE EXHALED AFTER INHALING,94150,CPT,0460,RC,,,,outpatient,,,342,34.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,123.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,123.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,126.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,123.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,257.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,130.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,123.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,130.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,611,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,125.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,123.14,611,,facility
DIHYDROTESTOSTERONE,82642,CPT,301,RC,,,,outpatient,,,182,18.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,22.51,22.51,22.51,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,29.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,61.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,31.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,29.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,31.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,56.93,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,29.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,29.28,448,,facility
PROGRAMMING OF MULTIPLE LEAD IMPLANTABLE DEFIBRILLATOR SYSTEM,93284,CPT,0480,RC,,,,outpatient,,,271,27.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,173.44,173.44,173.44,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,35.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,74.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,32.47,32.47,38.02,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1463,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,36.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.71,1463,,facility
INJECTION BENEATH LINING OF LOWER LARGE BOWEL USING A FLEXIBLE ENDOSCOPE,45335,CPT,0750,RC,,,,outpatient,,,3740,374,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,799.94,799.94,811.89,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,890.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,890.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,916.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,1679.25,1679.25,1679.25,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,1256.64,1256.64,1256.64,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,890.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1860.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,943.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,890.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,943.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2712,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,907.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,2712,,facility
IN GEMCITABINE HCL NOS 200MG,J9201,HCPCS,636,RC,,,,outpatient,,,977,97.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,52.8,,239.1,191.59,239.1,34,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,70.26,70.26,70.89,24,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,71.41,34.53,71.41,45,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",448,448,,facility
UNLISTD NONINVAS VASC DX STD,93998,CPT,921,RC,,,,outpatient,,,982,98.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,27.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,57.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,29.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,27.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,29.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1227,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,28.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,27.68,1227,,facility
SC STD ENZYME DETCJ PER NZM,87185,CPT,306,RC,,,,outpatient,,,808,80.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.23,4.23,4.23,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,9.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.23,4.23,4.23,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.26,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,4.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,4.75,448,,facility
DETECTION TEST BY NUCLEIC ACID FOR ENTEROVIRUS (INTESTINAL VIRUS); AMPLIFIED PROBE TECHNIQUE,87498,CPT,0306,RC,,,,outpatient,,,384,38.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
DETECT AGENT NOS DNA AMP,87798,CPT,306,RC,,,,outpatient,,,1280,128,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,110.88,110.88,174.24,1 through 10,percent of total billed charges,,,33.6,,244.27,244.27,244.27,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,96.77,32.38,119.79,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,38.9,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
COMPLETE CBC W/AUTO DIFF WBC,85025,CPT,305,RC,,,,outpatient,,,4,0.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,6.91,6.91,6.91,1297,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,36.48,36.16,237.44,624,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,33.63,33.34,218.89,55,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,36.16,36.16,36.16,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,124.66,19.15,211.84,728,percent of total billed charges,,,33.6,,124.66,19.15,195.89,174,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,19.15,19.15,125.77,706,percent of total billed charges,,,34.6,,134.67,21.53,141.35,26,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,7.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,16.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,28.5,28.25,185.5,63,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,77.91,11.97,77.91,28,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,0.22,0.22,0.22,1 through 10,percent of total billed charges,,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,6.91,6.91,6.91,5659,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,7.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.78,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,7.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,7.77,448,,facility
PROTHROMBIN TIME,85610,CPT,305,RC,,,,outpatient,,,4.4,0.44,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.82,3.82,3.82,148,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,25.6,25.6,68.48,85,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,63.13,63.13,63.13,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,35.95,16.37,61.1,101,percent of total billed charges,,,33.6,,21.12,13.44,56.5,20,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,13.56,13.44,36.27,76,percent of total billed charges,,,34.6,,38.84,38.84,40.77,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,8.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,53.5,20,141,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,22.47,8.4,22.47,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.82,3.82,3.82,801,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.49,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,4.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,4.29,448,,facility
IMMUNOASSAY NONANTIBODY,83516,CPT,301,RC,,,,outpatient,,,275,27.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9,9,10.26,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,4.75,4.75,218.59,30,percent of total billed charges,,,33.6,,3.02,3.02,175.39,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,3.02,3.02,211.68,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,24.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,23.5,23.5,23.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9,9,10.26,51,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.92,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,11.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.53,448,,facility
HIV-1 PROBE&REVERSE TRNSCRPJ,87535,CPT,306,RC,,,,outpatient,,,64,6.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,122.13,122.13,122.13,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,38.98,38.98,61.25,1 through 10,percent of total billed charges,,,33.6,,618.82,618.82,618.82,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,38.48,38.48,42.11,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
FLUORESCENT ANTIBODY TITER,86256,CPT,302,RC,,,,outpatient,,,139,13.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.72,10.72,10.72,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.04,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.05,448,,facility
ASSAY OF PYRUVATE KINASE,84220,CPT,301,RC,,,,outpatient,,,120,12,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,9.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,19.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,8.4,8.4,8.4,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,9.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.41,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,9.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,9.44,448,,facility
CLOT FACTOR XII HAGEMAN,85280,CPT,305,RC,,,,outpatient,,,85.5,8.55,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,40.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,20.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,17.21,17.21,17.21,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,20.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,41.81,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,19.35,448,,facility
BORDETELLA ANTIBODY,86615,CPT,302,RC,,,,outpatient,,,60,6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.73,11.73,11.73,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.49,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.19,448,,facility
CYTOG ALYS CHRML ABNR CGH,81228,CPT,310,RC,,,,outpatient,,,1333,133.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,900,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,900,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,927,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,900,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1881,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,954,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,900,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,954,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1575,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,918,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1881,,facility
ASSAY OF AMIKACIN,80150,CPT,301,RC,,,,outpatient,,,43.75,4.38,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,31.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.57,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,15.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,15.08,448,,facility
VITAMIN D 25 HYDROXY,82306,CPT,301,RC,,,,outpatient,,,22.5,2.25,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,26.33,26.33,26.33,345,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,123.9,123.9,399.43,17,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,110.88,70.56,357.46,103,percent of total billed charges,,,33.6,,71.19,70.56,227.47,16,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,70.56,70.56,227.47,175,percent of total billed charges,,,34.6,,257.94,257.94,257.94,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,29.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,61.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,31.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,105,105,338.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,142.17,44.1,142.17,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,26.33,26.33,26.33,1001,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,29.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,31.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,63.96,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,30.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,29.6,448,,facility
ASSAY OF VOLATILES,84600,CPT,301,RC,,,,outpatient,,,65.5,6.55,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,35.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,34.74,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.11,448,,facility
HEMOGLOBIN ELECTROPHORESIS,83020,CPT,301,RC,,,,outpatient,,,226,22.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.45,11.45,11.45,22,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,12.1,12.1,12.29,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,26.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,18,18,18,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,29.19,29.19,29.19,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.45,11.45,11.45,47,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.81,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.87,448,,facility
SPECIMEN INFECT AGNT CONCNTJ,87015,CPT,306,RC,,,,outpatient,,,50,5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.94,5.94,5.94,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,13.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,7.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.94,5.94,5.94,23,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,7.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.42,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,6.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,6.68,448,,facility
CELL FUNCTION ASSAY W/STIM,86352,CPT,302,RC,,,,outpatient,,,363,36.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,135.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,135.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,139.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,210.52,210.52,210.52,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,135.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,283.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,144.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,120.85,120.85,120.85,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,135.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,144.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,293.53,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,138.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,135.86,448,,facility
VITAMIN D 25 HYDROXY,82306,CPT,301,RC,,,,outpatient,,,157.5,15.75,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,26.33,26.33,26.33,345,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,123.9,123.9,399.43,17,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,110.88,70.56,357.46,103,percent of total billed charges,,,33.6,,71.19,70.56,227.47,16,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,70.56,70.56,227.47,175,percent of total billed charges,,,34.6,,257.94,257.94,257.94,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,29.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,61.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,31.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,105,105,338.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,142.17,44.1,142.17,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,26.33,26.33,26.33,1001,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,29.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,31.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,63.96,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,30.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,29.6,448,,facility
ASSAY OF SERUM SODIUM,84295,CPT,301,RC,,,,outpatient,,,15,1.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.28,4.28,4.28,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,9.62,9.62,9.62,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,36.54,21.5,36.54,1 through 10,percent of total billed charges,,,33.6,,21.5,21.5,21.5,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,21.5,16.47,43.01,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,10.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.28,4.28,4.28,39,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.4,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,4.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,4.81,448,,facility
ASSAY OF SIALIC ACID,84275,CPT,301,RC,,,,outpatient,,,265,26.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,28.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.03,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.44,448,,facility
SC STD DISK METHOD PER PLATE,87184,CPT,306,RC,,,,outpatient,,,67,6.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,7.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,15.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,7.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,6.65,6.65,6.65,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,7.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,7.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.89,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,7.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,7.48,448,,facility
SPECTROPHOTOMETRY,84311,CPT,301,RC,,,,outpatient,,,86.25,8.63,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,7.2,7.2,7.2,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,45.35,45.35,53.33,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,16.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,7.2,7.2,7.2,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.1,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,8.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,8.1,448,,facility
CHORIONIC GONADOTROPIN TEST,84702,CPT,301,RC,,,,outpatient,,,39,3.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.39,13.39,13.39,99,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,35.99,35.99,146.32,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,32.21,32.21,141.61,16,percent of total billed charges,,,33.6,,32.21,20.5,83.33,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,20.5,20.5,83.33,45,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,31.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,12.81,12.81,12.81,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,13.39,13.39,13.39,1 through 10,percent of total billed charges,,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.39,13.39,13.39,208,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.53,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,15.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,15.05,448,,facility
DRUG ASSAY FELBAMATE,80167,CPT,301,RC,,,,outpatient,,,40.4,4.04,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.62,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.64,448,,facility
FUNGI IDENTIFICATION MOLD,87107,CPT,306,RC,,,,outpatient,,,14,1.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,70.56,70.56,70.56,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,70.56,70.56,70.56,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,21.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9.18,9.18,9.18,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.3,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,10.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,10.32,448,,facility
CARDIOLIPIN ANTIBODY EA IG,86147,CPT,302,RC,,,,outpatient,,,216,21.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,22.64,22.64,22.64,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,72.86,42.34,163.68,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,50.06,50.06,137.76,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,25.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,53.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,26.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,22.64,22.64,22.64,31,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,25.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,26.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,54.99,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,25.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,25.45,448,,facility
NEURO CSF PRION PRTN QUAL,0035U,CPT,300,RC,,,,outpatient,,,836,83.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,540.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,540.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,557.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,540.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1130.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,573.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,540.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,573.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,946.73,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,551.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1130.67,,facility
ANTINUCLEAR ANTIBODIES,86038,CPT,302,RC,,,,outpatient,,,140,14,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.75,10.75,10.75,34,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,148.09,148.09,148.09,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,84.34,29.04,132.53,14,percent of total billed charges,,,33.6,,84.34,18.48,127.78,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,84.34,84.34,85.09,12,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,11.55,11.55,11.55,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.75,10.75,10.75,126,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.11,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.09,448,,facility
ENTEROVIRUS PROBE&REVRS TRNS,87498,CPT,306,RC,,,,outpatient,,,235,23.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
M.TUBERCULO DNA AMP PROBE,87556,CPT,306,RC,,,,outpatient,,,457,45.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,41.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,41.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,41.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,87.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,44.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,41.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,44.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,42.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,41.68,448,,facility
UNLISTED MOLECULAR PATHOLOGY,81479,CPT,310,RC,,,,outpatient,,,755,75.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,561.56,561.56,561.56,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,32.5,32.5,3071.5,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
T CELLS TOTAL COUNT,86359,CPT,302,RC,,,,outpatient,,,179,17.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,33.56,33.56,33.56,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,37.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,37.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,82.68,82.68,82.68,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,78.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,39.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,33.56,33.56,33.56,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,39.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,81.52,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,38.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,37.73,448,,facility
EPSTEIN-BARR NUCLEAR ANTIGEN,86664,CPT,302,RC,,,,outpatient,,,111,11.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.6,13.6,13.6,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,49.92,22.4,49.92,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,41.18,41.18,41.18,1 through 10,percent of total billed charges,,,33.6,,71.57,71.57,71.57,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,28.56,28.56,71.57,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,31.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.6,13.6,13.6,15,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,33.04,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,15.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,15.29,448,,facility
NEURO CSF PRION PRTN QUAL,0035U,CPT,300,RC,,,,outpatient,,,923,92.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,540.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,540.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,557.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,540.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1130.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,573.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,540.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,573.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,946.73,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,551.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1130.67,,facility
DETECT AGENT NOS DNA AMP,87798,CPT,306,RC,,,,outpatient,,,60,6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,110.88,110.88,174.24,1 through 10,percent of total billed charges,,,33.6,,244.27,244.27,244.27,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,96.77,32.38,119.79,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,38.9,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
RBC ANTIBODY IDENTIFICATION,86870,CPT,302,RC,,,,outpatient,,,90,9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,315.62,315.62,343.05,52,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,343.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,343.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,353.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,289.34,289.34,578.69,17,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,198.92,198.92,596.77,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,343.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,716.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,363.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,23.42,23.42,46.84,19,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,343.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,363.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,377,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,349.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,343.05,716.97,,facility
IMMUNOASSAY QUANT NOS NONAB,83520,CPT,301,RC,,,,outpatient,,,820,82,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,36,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,66.08,66.08,66.08,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,41.18,24.82,318.38,1 through 10,percent of total billed charges,,,33.6,,37.63,37.63,96.43,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,33.6,23.18,176.4,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,36.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,87,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.22,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.27,448,,facility
ASSAY OF ALDOSTERONE,82088,CPT,301,RC,,,,outpatient,,,62,6.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,36.25,36.25,36.25,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,32.45,32.45,63.72,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,40.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,40.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,41.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,29.04,18.48,29.04,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,18.48,17.81,46.37,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,40.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,85.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,43.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,36.25,36.25,36.25,24,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,40.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,43.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,88.04,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,41.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,40.75,448,,facility
ASSAY OF ALDOLASE,82085,CPT,301,RC,,,,outpatient,,,27.7,2.77,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,8.64,8.64,8.64,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,40.13,40.13,40.26,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,25.54,25.54,33.6,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,9.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,20.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,8.64,8.64,8.64,15,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,9.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.98,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,9.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,9.71,448,,facility
ASSAY OF GONADOTROPIN (LH),83002,CPT,301,RC,,,,outpatient,,,21,2.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.47,16.47,16.47,47,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,174.64,174.64,174.64,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,45.41,45.28,156.29,14,percent of total billed charges,,,33.6,,45.41,29.07,99.46,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,28.9,28.9,99.46,15,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,43,43,43,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,18.06,18.06,18.06,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.47,16.47,16.47,101,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,40.01,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.52,448,,facility
HBB GENE DUP/DEL VARIANTS,81363,CPT,310,RC,,,,outpatient,,,3033,303.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,202.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,202.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,208.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,202.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,423.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,214.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,202.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,214.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,354.2,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,206.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,202.4,448,,facility
MICROSOMAL ANTIBODY EACH,86376,CPT,302,RC,,,,outpatient,,,39.3,3.93,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.94,12.94,12.94,22,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,22.18,14.11,82.9,1 through 10,percent of total billed charges,,,33.6,,22.51,22.51,22.51,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,22.51,11.27,81.98,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,30.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.94,12.94,12.94,63,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,31.43,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.55,448,,facility
CHEMILUMINESCENT ASSAY,82397,CPT,301,RC,,,,outpatient,,,249,24.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.56,12.56,12.56,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,22.85,22.85,22.85,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,29.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.56,12.56,12.56,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.5,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.12,448,,facility
T CELLS TOTAL COUNT,86359,CPT,302,RC,,,,outpatient,,,114,11.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,33.56,33.56,33.56,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,37.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,37.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,82.68,82.68,82.68,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,78.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,39.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,33.56,33.56,33.56,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,39.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,81.52,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,38.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,37.73,448,,facility
VIRUS INOCULATION TISSUE,87252,CPT,306,RC,,,,outpatient,,,183,18.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,26.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,54.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,27.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,26.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,27.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,56.32,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,26.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,26.07,448,,facility
IMMUNOASSAY TUMOR CA 125,86304,CPT,302,RC,,,,outpatient,,,29,2.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,18.51,18.51,18.51,13,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,29.13,29.13,29.13,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,195.36,59.14,195.36,12,percent of total billed charges,,,33.6,,59.14,59.14,125.43,21,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,124.32,37.63,125.43,21,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,20.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,43.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,185,56.13,185,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,77.7,77.7,77.7,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,18.51,18.51,18.51,51,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,20.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,44.98,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,21.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,20.81,448,,facility
PMS2 GENE FULL SEQ ANALYSIS,81317,CPT,310,RC,,,,outpatient,,,262,26.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,676.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,676.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,696.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,676.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1413.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,717.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,676.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,717.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1237.29,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,690.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1413.88,,facility
RBC SERUM PRETX INCUBJ DRUGS,86975,CPT,302,RC,,,,outpatient,,,130,13,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,427.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,427.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,440.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,427.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,893.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,453.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,427.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,453.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,55.65,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,436.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,55.65,893.56,,facility
NFCT AGT GNTYP ALYS HIV1,87906,CPT,306,RC,,,,outpatient,,,150,15,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,120.95,120.95,120.95,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,128.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,128.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,132.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,108.24,108.24,108.24,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,128.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,269.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,136.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,114.5,114.5,114.5,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,128.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,136.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,278.11,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,131.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,128.73,448,,facility
BLOOD TYPING SEROLOGIC RH(D),86901,CPT,302,RC,,,,outpatient,,,234,23.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,2.66,2.66,62.15,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,155.76,19.47,155.76,14,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,88.7,17.42,150.74,116,percent of total billed charges,,,33.6,,88.7,17.42,88.7,44,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,88.7,11.09,100.58,78,percent of total billed charges,,,34.6,,97.68,95.83,100.58,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,74.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,132,16.5,132,13,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,55.44,6.93,55.44,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,2.66,2.66,2.66,1 through 10,percent of total billed charges,,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,2.66,2.66,2.66,829,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.46,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,36.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,6.46,448,,facility
CMV ANTIBODY,86644,CPT,302,RC,,,,outpatient,,,35,3.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.8,12.8,12.8,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,30.08,30.08,85.12,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,70.22,44.69,76.56,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,49.24,48.72,49.24,1 through 10,percent of total billed charges,,,34.6,,48.28,17.91,50.67,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,30.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.8,12.8,12.8,11,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,31.1,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.39,448,,facility
ASSAY OF LITHIUM,80178,CPT,301,RC,,,,outpatient,,,12,1.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.88,5.88,5.88,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,27.29,27.22,42.77,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,13.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,7.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.88,5.88,5.88,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,7.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.28,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,6.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,6.61,448,,facility
QUANTITATIVE ASSAY DRUG,80299,CPT,301,RC,,,,outpatient,,,116.25,11.63,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,13,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,174.64,174.64,174.64,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,171.6,171.6,171.6,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,374.52,374.52,374.52,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.62,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.64,448,,facility
ASSAY OF RBC GALACTOKINASE,82759,CPT,301,RC,,,,outpatient,,,673,67.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,21.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,44.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,21.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,46.41,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,21.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,21.48,448,,facility
RPR S/N/A/GEN/TRK12.6-20.0CM,12005,CPT,761,RC,,,,outpatient,,,474.9,47.49,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,400.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,813.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,412.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,412.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,396.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,389.05,1311,,facility
INSERT AND REMOVE BONE PIN,20650,CPT,450,RC,,,,outpatient,,,3855.04,385.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1027,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1519,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3131.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3131.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3225.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3131.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,6544.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3319.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3131.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3319.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3194.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,6544.81,,facility
TX CLSD ELBOW DISLC REQ ANES,24605,CPT,761,RC,,,,outpatient,,,1914.16,191.42,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1585.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3216.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1631.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1631.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,1569.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3216.38,,facility
LEFT HRT CATH W/VENTRCLGRPHY,93452,CPT,480,RC,,,,outpatient,,,3880.91,388.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2004,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,2759,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,3102.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3102.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3195.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3102.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,6484.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3288.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3102.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3288.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1463,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,3164.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,1463,6484.66,,facility
INCISE/DRAIN EYELID LINING,68020,CPT,361,RC,,,,outpatient,,,1205.8,120.58,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,954.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,954.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,982.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,954.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1994.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1011.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,954.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1011.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3821,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,973.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3821,,facility
EVOKED AUDITORY TEST LIMITED,92587,CPT,471,RC,,,,outpatient,,,373.83,37.38,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,206.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,206.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,212.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,206.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,431.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,219.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,206.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,219.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,425,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,210.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,206.65,448,,facility
VASCULAR STUDY,93979,CPT,921,RC,,,,outpatient,,,130.94,13.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1227,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,1227,,facility
MYELOGRAPHY LUMBAR INJECTION,62305,CPT,361,RC,,,,outpatient,,,953.6,95.36,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,750.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,750.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,772.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,750.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1568.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,795.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,750.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,795.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2712,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,765.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,2712,,facility
CLTX CLAVICULAR FX W/O MNPJ,23500,CPT,761,RC,,,,outpatient,,,280.86,28.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,210.47,210.47,210.47,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,243.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,493.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,213.62,213.62,213.62,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,240.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,236.08,1173,,facility
CLSD TX PELVIC RING FX,27198,CPT,450,RC,,,,outpatient,,,280.86,28.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,243.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,493.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,240.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,236.08,1173,,facility
STRAPPING OF SHOULDER,29240,CPT,450,RC,,,,outpatient,,,152.14,15.21,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,131.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,266.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,134.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,134.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,129.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,127.33,448,,facility
CYP3A4 GENE COMMON VARIANTS,81230,CPT,310,RC,,,,outpatient,,,218.51,21.85,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,174.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,174.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,180.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,174.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,365.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,185.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,174.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,185.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,305.92,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,178.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,174.81,448,,facility
DESTROY LUMB/SAC FACET JNT,64635,CPT,361,RC,,,,outpatient,,,2299.54,229.95,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,1868.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1868.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1924.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1868.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3905.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1981,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,1332.52,1332.52,1738.97,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1868.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1981,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9389,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1906.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,9389,,facility
TREAT KNUCKLE DISLOCATION,26700,CPT,761,RC,,,,outpatient,,,280.86,28.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,243.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,493.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,240.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,236.08,493.41,,facility
SURGICAL PATH GROSS,88300,CPT,310,RC,,,,outpatient,,,35.46,3.55,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,14.72,14.72,14.72,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,44.9,44.9,44.9,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,26.1,26.1,26.1,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,27.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,57.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,29.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9.96,9.96,9.97,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,27.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,29.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.57,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,28.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,27.68,448,,facility
SMALL BOWEL ENDOSCOPY,44363,CPT,750,RC,,,,outpatient,,,2266.24,226.62,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,1836.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1836.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1891.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1836.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3838.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1946.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1836.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1946.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3821,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1873.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3838.31,,facility
INTERROGATE SUBQ DEFIB,93261,CPT,480,RC,,,,outpatient,,,44.91,4.49,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,35.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,74.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1463,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,36.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.71,1463,,facility
CHANGE G-TUBE TO G-J PERC,49446,CPT,361,RC,,,,outpatient,,,2266.24,226.62,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,1836.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1836.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1891.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1836.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3838.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1946.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1836.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1946.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3821,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1873.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3838.31,,facility
T CELLS TOTAL COUNT,86359,CPT,302,RC,,,,outpatient,,,47.16,4.72,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,33.56,33.56,33.56,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,37.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,37.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,82.68,82.68,82.68,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,78.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,39.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,33.56,33.56,33.56,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,39.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,81.52,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,38.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,37.73,448,,facility
CLTX ACROMCLAV DISLC WO MNPJ,23540,CPT,450,RC,,,,outpatient,,,280.86,28.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,243.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,493.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,240.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,236.08,1173,,facility
INTMD RPR N-HF/GENIT12.6-20,12045,CPT,450,RC,,,,outpatient,,,748,74.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,707.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,707.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,728.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,707.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1478.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,749.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,707.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,749.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,721.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1478.34,,facility
VIRUS ANTIBODY NOS,86790,CPT,302,RC,,,,outpatient,,,42,4.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.46,11.46,11.46,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,107.86,20.06,169.49,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,116.52,40.29,122.3,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,26.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.46,11.46,11.46,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.88,448,,facility
OTHER SOURCE ALBUMIN QUAN EA,82042,CPT,301,RC,,,,outpatient,,,7,0.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,107.76,107.76,107.76,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,7.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,16.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,6.92,6.92,6.92,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,7.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.62,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,7.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,7.78,448,,facility
IMMUNOASSAY QUANT NOS NONAB,83520,CPT,301,RC,,,,outpatient,,,86.65,8.67,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,36,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,66.08,66.08,66.08,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,41.18,24.82,318.38,1 through 10,percent of total billed charges,,,33.6,,37.63,37.63,96.43,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,33.6,23.18,176.4,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,36.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,87,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.22,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.27,448,,facility
SMN1 GENE DOS/DELETION ALYS,81329,CPT,310,RC,,,,outpatient,,,193,19.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,121.86,121.86,121.86,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,137,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,137,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,141.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,471.5,471.5,471.5,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,300.05,300.05,302.73,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,137,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,286.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,145.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,121.86,121.86,121.86,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,137,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,145.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,239.75,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,139.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,137,448,,facility
ASSAY OF CREATINE,82540,CPT,301,RC,,,,outpatient,,,30,3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,9.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.01,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,4.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,4.64,448,,facility
CALCULUS SPECTROSCOPY,82365,CPT,301,RC,,,,outpatient,,,34.4,3.44,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.47,11.47,11.47,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,31.92,31.92,31.92,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,26.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.47,11.47,11.47,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.86,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.9,448,,facility
PROTOZOA ANTIBODY NOS,86753,CPT,302,RC,,,,outpatient,,,57,5.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.02,11.02,11.02,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,98.11,98.11,154.18,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,96.77,32.38,106,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.02,11.02,11.02,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.76,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.39,448,,facility
C DIFF AMPLIFIED PROBE,87493,CPT,306,RC,,,,outpatient,,,70.25,7.03,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,350.46,350.46,350.46,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,37.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,37.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,554.36,554.36,554.36,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,199.58,199.58,199.58,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,77.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,39.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,39.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,38.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,37.27,448,,facility
CHROMOSOME ANALYS PLACENTA,88267,CPT,311,RC,,,,outpatient,,,150,15,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,188.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,188.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,194.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,188.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,394.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,199.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,188.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,199.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,388.41,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,192.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,188.57,448,,facility
ASSAY NEPHELOMETRY NOT SPEC,83883,CPT,301,RC,,,,outpatient,,,133.8,13.38,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.1,12.1,12.1,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,173.18,51.22,173.18,1 through 10,percent of total billed charges,,,33.6,,31.58,31.58,31.58,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,31.58,31.53,110.21,11,percent of total billed charges,,,34.6,,119.06,117.35,124.97,24,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,28.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.1,12.1,12.1,29,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.38,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.6,448,,facility
ASSAY OF UREA NITROGEN,84520,CPT,301,RC,,,,outpatient,,,4.5,0.45,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.51,3.51,3.51,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,7.9,7.9,7.9,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,37.69,22.18,37.69,1 through 10,percent of total billed charges,,,33.6,,22.18,22.18,22.18,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,22.18,19.49,43.73,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,8.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.51,3.51,3.51,46,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.54,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,4.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,3.95,448,,facility
DRUG SCREENING BARBITURATES,80345,CPT,301,RC,,,,outpatient,,,655,65.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
HERPES SIMPLEX TYPE 1 TEST,86695,CPT,302,RC,,,,outpatient,,,20,2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.73,11.73,11.73,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,20.59,20.59,42.71,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,13.1,13.1,13.1,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.73,11.73,11.73,15,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.49,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.19,448,,facility
ASSAY OF HOMOVANILLIC ACID,83150,CPT,301,RC,,,,outpatient,,,28.01,2.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,23.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,46.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,23.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.93,19.93,19.93,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,23.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,41.81,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,22.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,22.41,448,,facility
VITAMIN B-12,82607,CPT,301,RC,,,,outpatient,,,18.85,1.89,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.41,13.41,13.41,130,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,57.82,57.82,193.52,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,51.74,32.93,173.18,47,percent of total billed charges,,,33.6,,32.93,32.93,110.21,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,32.93,32.93,33.22,71,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,31.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,49,49,49,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,68.88,68.88,68.88,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.41,13.41,13.41,332,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.57,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,15.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,15.08,448,,facility
GENOME SEQUENCE ANALYSIS,81425,CPT,310,RC,,,,outpatient,,,6289,628.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5031.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5031.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5182.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5031.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,10515.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5333.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5031.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5333.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8804.6,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5131.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,10515.21,,facility
ASSAY OF GGT,82977,CPT,301,RC,,,,outpatient,,,9,0.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,6.4,6.4,6.4,117,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,231.28,231.28,231.28,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,223.83,36.43,223.83,54,percent of total billed charges,,,33.6,,131.71,23.18,206.98,13,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,23.39,23.18,132.89,33,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,6.4,6.4,6.4,1 through 10,percent of total billed charges,,7.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,15.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,7.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,196,34.5,196,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,6.4,6.4,6.4,714,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,7.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,7.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.56,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,7.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,7.2,448,,facility
SMEAR COMPLEX STAIN,87209,CPT,306,RC,,,,outpatient,,,22.48,2.25,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15,15,15.99,19,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,9.6,9.6,9.6,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,7.92,5.04,7.92,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,5.04,5.04,5.04,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,37.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15,15,15.99,18,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.98,448,,facility
REFILL/MAINT PUMP/RESVR SYST,96522,CPT,335,RC,,,,outpatient,,,255.28,25.53,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,203.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,203.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,209.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,203.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,425.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,215.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,203.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,215.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1603,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,207.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,203.57,1603,,facility
MOPATH PROCEDURE LEVEL 2,81401,CPT,310,RC,,,,outpatient,,,710,71,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,121.86,121.86,121.86,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,137,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,137,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,141.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,137,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,286.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,145.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,137,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,145.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,239.75,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,139.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,137,448,,facility
ELECTROPHORESIS; LABORATORY TESTING TECHNIQUE,82664,CPT,0301,RC,,,,outpatient,,,190,19,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,61.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,61.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,63.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,61.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,128.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,65.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,61.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,65.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,107.63,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,62.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,61.5,448,,facility
ENCEPHALITIS CALIFORN ANTBDY,86651,CPT,302,RC,,,,outpatient,,,130,13,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.49,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.19,448,,facility
HERPES SIMPLEX TYPE 2 TEST,86696,CPT,302,RC,,,,outpatient,,,225,22.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,17.21,17.21,17.21,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,20.59,20.59,42.71,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,13.1,13.1,13.1,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,40.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,20.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,17.21,17.21,17.21,12,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,20.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,41.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,19.35,448,,facility
ASSAY OF FREE THYROXINE,84439,CPT,301,RC,,,,outpatient,,,503,50.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,8.02,8.02,8.02,335,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,53.1,53.1,309.16,13,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,47.52,30.24,276.67,112,percent of total billed charges,,,33.6,,47.52,30.24,276.67,25,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,30.24,30.24,176.06,119,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,9.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,18.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,9.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,45.13,45,262,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,18.9,18.9,18.9,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,8.02,8.02,8.02,954,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,9.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,9.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.48,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,9.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,9.02,448,,facility
UPPER EXTREMITY STUDY,93931,CPT,921,RC,,,,outpatient,,,130.94,13.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1227,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,1227,,facility
FUNGUS ISOLATION CULTURE,87102,CPT,306,RC,,,,outpatient,,,10.51,1.05,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,7.48,7.48,7.48,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,206.98,206.98,325.25,1 through 10,percent of total billed charges,,,33.6,,206.98,206.98,206.98,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,206.98,206.98,206.98,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,17.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,7.48,7.48,7.48,47,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.17,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,8.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,8.41,448,,facility
CLSD TX NSL FX W/MNPJ&STABLJ,21320,CPT,761,RC,,,,outpatient,,,3834.53,383.45,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3173.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3173.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3268.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3173.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,6631.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3363.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3173.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3363.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,3236.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,6631.76,,facility
HTLV-I ANTIBODY,86687,CPT,302,RC,,,,outpatient,,,11.36,1.14,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,9.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,9.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,9.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,9.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.13,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,9.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,9.09,448,,facility
TREAT HIP DISLOCATION,27252,CPT,761,RC,,,,outpatient,,,1914.16,191.42,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1585.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3216.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1631.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1631.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,1569.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3216.38,,facility
ASSAY OF ZINC,84630,CPT,301,RC,,,,outpatient,,,14.24,1.42,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.13,10.13,10.13,19,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,31.68,14.11,31.68,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,20.16,20.16,74.92,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,23.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,30,30,30,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.13,10.13,10.13,43,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.61,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,11.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.39,448,,facility
ASSAY OF APOLIPOPROTEIN,82172,CPT,301,RC,,,,outpatient,,,26.36,2.64,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,18.76,18.76,18.76,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,22.18,20.16,31.68,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,20.16,20.16,20.34,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,21.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,44.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,18.76,18.76,18.76,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,21.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.91,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,21.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,21.09,448,,facility
ASY HYDROXYCORTICOSTEROIDS17,83491,CPT,301,RC,,,,outpatient,,,22.38,2.24,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,37.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,37.87,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.9,448,,facility
"RBC, FRZ/DEG/WSH, L/R, IRRAD",P9057,HCPCS,390,RC,,,,outpatient,,,615.88,61.59,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,420.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,420.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,433.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,420.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,879.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,445.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,420.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,445.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,107,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,429.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,107,879.1,,facility
DRAINAGE OF SCROTUM ABSCESS,55100,CPT,761,RC,,,,outpatient,,,1930.94,193.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1628.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3303.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1675.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1675.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,1612.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3303.62,,facility
RADIATION THERAPY DOSE PLAN,77300,CPT,333,RC,,,,outpatient,,,161.6,16.16,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,4320,1440,5760,32,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,6637.5,6637.5,6637.5,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,128.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,128.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,132.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,1512,756,3564,13,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,1525.5,1512,4536,13,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,128.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,268.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,136.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,1125,1125,5625,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,27.77,27.77,27.77,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,128.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,136.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,48815,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,131.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,128.64,48815,,facility
SMALL BOWEL ENDOSCOPY/BIOPSY,44361,CPT,750,RC,,,,outpatient,,,2266.24,226.62,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,1836.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1836.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1891.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1836.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3838.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1946.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1836.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1946.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3821,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1873.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3838.31,,facility
INJ RETACRIT NON-ESRD USE,Q5106,HCPCS,636,RC,,,,outpatient,,,8.53,0.85,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,7.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,7.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,16.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,7.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.06,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,8.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,7.97,448,,facility
INJ IRON DEXTRAN,J1750,HCPCS,636,RC,,,,outpatient,,,22.49,2.25,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,30.07,30.07,1008,22,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,18.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,806.26,20.67,831.6,126,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,512.99,13.15,533.93,65,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,39.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,20.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,20.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,37.41,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.99,448,,facility
CLTX RDL SHFT FX&DISLC,25520,CPT,761,RC,,,,outpatient,,,1914.16,191.42,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1585.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3216.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1631.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1631.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,1569.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3216.38,,facility
ASSAY OF PREGNENOLONE,84140,CPT,301,RC,,,,outpatient,,,25.84,2.58,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,20.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,43.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,21.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,20.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,21.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,44.66,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,21.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,20.67,448,,facility
CYP2C19 GENE COM VARIANTS,81225,CPT,310,RC,,,,outpatient,,,364.2,36.42,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,291.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,291.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,300.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,291.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,608.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,308.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,291.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,308.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,509.88,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,297.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,291.36,608.94,,facility
ASSAY OF RENIN,84244,CPT,301,RC,,,,outpatient,,,27.49,2.75,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.56,19.56,19.56,13,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,24.19,24.19,63.13,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,21.65,13.78,21.65,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,13.78,13.78,35.95,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,21.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,45.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,23.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.56,19.56,19.56,29,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,21.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,23.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,47.51,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,22.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,21.99,448,,facility
"INJECTION, FULPHILA",Q5108,HCPCS,636,RC,,,,outpatient,,,184.69,18.47,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,67.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,67.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,69.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,67.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,140.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,71.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,67.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,71.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,269.4,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,68.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,67.02,448,,facility
IGG 1 2 3 OR 4 EACH,82787,CPT,301,RC,,,,outpatient,,,10.03,1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,52.8,13.2,263.18,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,33.9,33.9,33.9,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,16.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.33,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,8.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,8.02,448,,facility
MEASURE KIDNEY PRESSURE,50396,CPT,361,RC,,,,outpatient,,,813.58,81.36,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,667.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,667.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,687.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,667.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1394.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,707.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,667.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,707.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2712,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,680.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,2712,,facility
EUGLOBULIN LYSIS,85360,CPT,305,RC,,,,outpatient,,,10.51,1.05,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,17.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.17,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,8.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,8.41,448,,facility
CYTOMEG DNA AMP PROBE,87496,CPT,306,RC,,,,outpatient,,,43.86,4.39,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
HIV-2 ANTIBODY,86702,CPT,302,RC,,,,outpatient,,,16.9,1.69,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,66.56,66.56,165.12,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,72.57,72.57,72.57,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,34.94,34.94,54.91,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,34.29,34.29,37.75,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,28.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.21,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.52,448,,facility
MRI FETAL SNGL/1ST GESTATION,74712,CPT,614,RC,,,,outpatient,,,291.84,29.18,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1025,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1350,,,,,,,case rate,NTE Percentage + Reimbursement Rate 85.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,235.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,477.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,242.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,242.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2407,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,232.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,228.36,2407,,facility
ANALYZE SPINE INFUS PUMP,62367,CPT,361,RC,,,,outpatient,,,355.74,35.57,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,293.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,293.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,302.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,293.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,614.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,311.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,293.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,311.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2440,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,299.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,293.95,2440,,facility
NJX AA&/STRD AX NERVE IMG,64417,CPT,361,RC,,,,outpatient,,,1085.56,108.56,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,846.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,846.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,871.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,846.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1769.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,897.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,846.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,897.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2712,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,863.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,2712,,facility
"INJECTION, RAMUCIRUMAB",J9308,HCPCS,636,RC,,,,outpatient,,,89.08,8.91,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,76.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,76.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,78.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,76.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,160.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,81.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,76.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,81.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,156.76,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,78.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,76.57,448,,facility
ECHO EXAM OF FETAL HEART,76828,CPT,402,RC,,,,outpatient,,,130.94,13.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,842.88,842.88,842.88,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,695.38,695.38,695.38,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,17.79,17.79,17.79,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,465,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,465,,facility
CREATININE CLEARANCE TEST,82575,CPT,301,RC,,,,outpatient,,,11.83,1.18,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,205.82,37.91,216.03,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,9.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,19.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,8.41,8.41,8.41,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,9.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.42,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,9.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,9.46,448,,facility
FRANCISELLA TULARENSIS,86668,CPT,302,RC,,,,outpatient,,,17.7,1.77,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.6,12.6,12.6,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,29.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.6,12.6,12.6,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.78,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.16,448,,facility
NJX AA&/STRD PARACRV NRV,64435,CPT,450,RC,,,,outpatient,,,823.63,82.36,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,675.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,675.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,695.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,675.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1411.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,716.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,675.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,716.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,689.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1411.94,,facility
CT CHEST SPINE W/O DYE,72128,CPT,352,RC,,,,outpatient,,,130.94,13.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,93.3,92.3,5120,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,403,,,,,,,case rate,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,371,,,,,,,case rate,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,875,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1050,,,,,,,case rate,NTE Percentage + Reimbursement Rate 85.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,1720.32,1720.32,2923.52,1 through 10,percent of total billed charges,,,33.6,,1720.32,1720.32,1720.32,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,1720.32,1720.32,1720.32,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,68.79,68.79,71.9,18,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1522,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,1522,,facility
LACTOFERRIN FECAL (QUAL),83630,CPT,301,RC,,,,outpatient,,,24.63,2.46,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,17.52,17.52,17.52,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,25.2,25.2,25.2,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,41.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,20.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,17.52,17.52,17.52,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,20.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.42,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,20.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,19.7,448,,facility
PTEN GENE FULL SEQUENCE,81321,CPT,310,RC,,,,outpatient,,,750,75,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,600,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,600,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,618,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,600,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1254,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,636,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,600,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,636,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1050,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,612,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1254,,facility
US EXAM CHEST,76604,CPT,402,RC,,,,outpatient,,,130.94,13.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,535.04,535.04,535.04,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,441.41,441.41,441.41,1 through 10,percent of total billed charges,,,33.6,,280.9,280.9,280.9,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,280.9,280.9,280.9,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,25.25,25.25,25.25,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,465,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,465,,facility
ASSAY OF QUINIDINE,80194,CPT,301,RC,,,,outpatient,,,18.25,1.83,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,30.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,31.55,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.6,448,,facility
EXC H-F-NK-SP B9+MARG 3.1-4,11424,CPT,761,RC,,,,outpatient,,,1930.94,193.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,1458.02,1458.02,1487.27,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1628.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3303.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1675.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1675.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,1612.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3303.62,,facility
BRCA1&2 GENE FULL SEQ ALYS,81163,CPT,310,RC,,,,outpatient,,,585,58.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,468,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,468,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,482.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,468,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,978.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,496.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,468,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,496.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,819,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,477.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,978.12,,facility
CLTX DST RDL FX/EPHYS SEP WO,25600,CPT,761,RC,,,,outpatient,,,280.86,28.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,243.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,493.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,240.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,236.08,1173,,facility
IRON SUCROSE INJECTION,J1756,HCPCS,636,RC,,,,outpatient,,,4,0.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,312.55,52.38,508.64,2360,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,52.8,,422.4,183.37,432.17,3500,percent of total billed charges,,,33.6,,268.8,268.8,268.8,800,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,248.72,179.59,274.97,605,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",448,448,,facility
PLACENTAL LACTOGEN,83632,CPT,301,RC,,,,outpatient,,,25.28,2.53,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,20.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,42.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,21.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,20.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,21.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,43.7,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,20.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,20.22,448,,facility
NFCT DS BV RNA VAG FLU ALG,81513,CPT,310,RC,,,,outpatient,,,178.29,17.83,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,142.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,142.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,146.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,142.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,298.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,151.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,142.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,151.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,249.6,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,145.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,142.63,448,,facility
REMOVAL OF SCROTUM LESION,55120,CPT,450,RC,,,,outpatient,,,2425.83,242.58,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2000.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2000.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2060.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2000.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,4181.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2120.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2000.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2120.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2040.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,4181.3,,facility
RSV DNA/RNA AMP PROBE,87634,CPT,306,RC,,,,outpatient,,,87.75,8.78,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,70.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,70.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,72.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,70.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,146.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,74.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,70.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,74.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,151.66,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,71.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,70.2,448,,facility
INFLUENZA ASSAY W/OPTIC,87804,CPT,306,RC,,,,outpatient,,,20.69,2.07,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,34.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.96,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,16.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,16.55,448,,facility
LEUPROLIDE ACETATE SUSPNSION,J9217,HCPCS,636,RC,,,,outpatient,,,225.68,22.57,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,160.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,160.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,165.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,160.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,335.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,169.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,160.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,169.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,388.7,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,163.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,160.34,448,,facility
ASSAY OF LIPOPROTEIN(A),83695,CPT,301,RC,,,,outpatient,,,17.9,1.79,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.74,12.74,12.74,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,21.65,13.78,33.26,13,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,21.17,21.17,21.19,14,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,29.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,31.5,31.5,31.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.74,12.74,12.74,13,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.97,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.32,448,,facility
HTLV-II ANTIBODY,86688,CPT,302,RC,,,,outpatient,,,17.5,1.75,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,29.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.26,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14,448,,facility
CT MAXILLOFACIAL W/DYE,70487,CPT,351,RC,,,,outpatient,,,218.83,21.88,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,156.2,154.84,381.77,32,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,403,,,,,,,case rate,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,371,,,,,,,case rate,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,411,411,411,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,875,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1050,,,,,,,case rate,NTE Percentage + Reimbursement Rate 85.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,172.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,3376.32,3376.32,3376.32,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,1986.77,1986.77,1986.77,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,350.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,177.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,81.99,81.99,86.04,14,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,177.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1522,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,171.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,167.87,1522,,facility
EXC TR-EXT MAL+MARG 0.5 CM/<,11600,CPT,761,RC,,,,outpatient,,,837.95,83.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,677.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,677.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,698.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,677.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1416.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,718.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,677.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,718.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,691.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1416.43,,facility
BTK GENE COMMON VARIANTS,81233,CPT,310,RC,,,,outpatient,,,219.25,21.93,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,175.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,175.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,180.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,175.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,366.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,185.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,175.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,185.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,306.95,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,178.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,175.4,448,,facility
URINE BACTERIA CULTURE,87088,CPT,306,RC,,,,outpatient,,,10.11,1.01,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,7.2,7.2,7.2,305,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,314.24,56.32,314.24,57,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,51.92,51.92,289.69,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,259.25,46.46,280.36,74,percent of total billed charges,,,33.6,,164.98,152.74,280.36,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,164.98,29.57,166.45,56,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,16.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,245.5,44.13,245.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,18.53,18.53,103.11,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,7.2,7.2,10.02,1 through 10,percent of total billed charges,,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,7.2,7.2,7.2,951,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.48,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,8.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,8.09,448,,facility
RELOCATE POCKET FOR DEFIB,33223,CPT,360,RC,,,,outpatient,,,2171.91,217.19,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,1974.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1974.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2033.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1974.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,4127.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2093.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1974.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2093.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3821,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,2014.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,4127.08,,facility
N BLOCK INJ CELIAC PELUS,64530,CPT,361,RC,,,,outpatient,,,1085.56,108.56,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,846.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,846.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,871.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,846.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1769.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,897.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,846.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,897.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2712,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,863.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,2712,,facility
CT LWR EXTREMITY W/O&W/DYE,73702,CPT,352,RC,,,,outpatient,,,218.83,21.88,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,403,,,,,,,case rate,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,371,,,,,,,case rate,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,875,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1050,,,,,,,case rate,NTE Percentage + Reimbursement Rate 85.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,172.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,350.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,177.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,177.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1522,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,171.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,167.87,1522,,facility
EGFR GENE COM VARIANTS,81235,CPT,310,RC,,,,outpatient,,,405.73,40.57,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,324.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,324.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,334.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,324.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,678.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,344.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,324.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,344.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,568.02,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,331.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,324.58,678.37,,facility
DESTRUCTION B9 LESIONS 15/>,17111,CPT,761,RC,,,,outpatient,,,238.44,23.84,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,174.34,174.34,174.34,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,197.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,401.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,203.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,176.95,176.95,180.67,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,203.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,195.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,192.01,1173,,facility
CLTX RDL SHFT FX W/MNPJ,25505,CPT,761,RC,,,,outpatient,,,1914.16,191.42,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1585.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3216.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1631.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1631.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,1569.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3216.38,,facility
"INJECTION, AVELUMAB, 10 MG",J9023,HCPCS,636,RC,,,,outpatient,,,118.41,11.84,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,108.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,108.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,111.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,108.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,227.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,115.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,108.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,115.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,208.44,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,110.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,108.64,448,,facility
ASSAY CARBAMAZEPINE TOTAL,80156,CPT,301,RC,,,,outpatient,,,18.21,1.82,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,47.04,47.04,47.04,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.96,12.96,12.96,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,31.47,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.57,448,,facility
ESOPHAGOSCOP MUCOSAL RESECT,43211,CPT,750,RC,,,,outpatient,,,2266.24,226.62,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,1836.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1836.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1891.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1836.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3838.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1946.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1836.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1946.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3821,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1873.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3838.31,,facility
RBC DEPLETION OF HARVEST,38212,CPT,815,RC,,,,inpatient,,,517.01,51.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Short Stay Lesser of + Days Threshold 1.00 + Stoploss First Dollar + Reimbursement Rate 57.00 + Basic Per Diem + Fixed Rate 5000.00 + Fixed Amount 157464.00,,,,0,other,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,Short Stay Lesser of + Days Threshold 1.00 + Stoploss First Dollar + Reimbursement Rate 72.00 + Basic Per Diem + Fixed Rate 10000.00 + Fixed Amount 56687.00,,,,0,other,NTE Percentage + Reimbursement Rate 85.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,47.3,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,facility
EXC H-F-NK-SP B9+MARG 1.1-2,11422,CPT,761,RC,,,,outpatient,,,1930.94,193.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,1421.6,1421.6,1487.27,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1628.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3303.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1675.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,1442.85,1442.85,1442.85,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1675.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,1612.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3303.62,,facility
I&D ISCHIORCT&/PERIRCT ABSC,46040,CPT,761,RC,,,,outpatient,,,1405.45,140.55,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1027,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1519,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1179.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,2393.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1213.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1213.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,1168.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,2393.57,,facility
DRAINAGE OF NOSE LESION,30000,CPT,450,RC,,,,outpatient,,,290.91,29.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,226.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,226.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,233.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,226.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,473.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,240.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,226.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,240.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,231.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,226.68,1173,,facility
ASSAY OF ESTROGEN,82672,CPT,301,RC,,,,outpatient,,,27.13,2.71,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.3,19.3,19.3,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,24.53,24.53,24.53,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,21.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,45.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.3,19.3,19.3,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,21.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,46.87,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,22.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,21.7,448,,facility
COLONOSCOPY W/RESECTION,45390,CPT,750,RC,,,,outpatient,,,3344.05,334.41,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,2656.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2656.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2736.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,3946.32,3946.32,3946.32,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2656.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,5552.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2815.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,282.71,282.71,282.71,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2656.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2815.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3821,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,2709.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,5552.02,,facility
PSYCL/NRPSYC TST AUTO RESULT,96146,CPT,918,RC,,,,outpatient,,,35.46,3.55,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,27.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,57.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,29.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,27.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,29.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1372,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,28.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,27.68,1372,,professional
EXC TR-EXT MAL+MARG 2.1-3 CM,11603,CPT,761,RC,,,,outpatient,,,837.95,83.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,625.13,625.13,625.13,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,677.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,677.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,698.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,677.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1416.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,718.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,626.56,626.56,626.56,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,677.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,718.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,691.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1416.43,,facility
RPR S/N/A/GEN/TRK20.1-30.0CM,12006,CPT,761,RC,,,,outpatient,,,474.9,47.49,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,400.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,813.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,412.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,412.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,396.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,389.05,1311,,facility
COLORECTAL SCRN; HI RISK IND,G0105,HCPCS,750,RC,,,,outpatient,,,1088.51,108.85,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,890.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,890.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,916.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,890.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1860.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,943.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,890.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,943.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2712,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,907.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,2712,,facility
N-INVAS EAR/PLS OXIMETRY MLT,94761,CPT,460,RC,,,,outpatient,,,1817,181.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,611,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",448,611,,facility
TREPONEMA PALLIDUM,86780,CPT,302,RC,,,,outpatient,,,203,20.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.78,11.78,11.78,612,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,10.62,10.62,50.15,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,9.5,6.05,48.53,46,percent of total billed charges,,,33.6,,6.05,6.05,44.88,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,6.05,6.05,28.56,66,percent of total billed charges,,,34.6,,73.69,20.19,77.34,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,9,9,42.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,17.85,17.85,17.85,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,11.78,11.78,11.78,1 through 10,percent of total billed charges,,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.78,11.78,11.78,550,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.6,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.24,448,,facility
ALANINE AMINO (ALT) (SGPT),84460,CPT,301,RC,,,,outpatient,,,61,6.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.71,4.71,4.71,14,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,391,391,391,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,223.26,61.13,223.26,47,percent of total billed charges,,,33.6,,131.38,131.38,223.26,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,131.38,20.5,132.55,20,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,11.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,195.5,195.5,195.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.71,4.71,4.71,309,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.45,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.3,448,,facility
REPAIR OF LACERATED MOUTH; MORE THAN 2.5 CM,40831,CPT,0450,RC,,,,outpatient,,,1388,138.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,516.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,516.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,531.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,516.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1078.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,547.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,453.49,453.49,453.49,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,516.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,547.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,526.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1173,,facility
INJ PEGFILGRAST EX BIO 0.5MG,J2506,HCPCS,636,RC,,,,outpatient,,,1481,148.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,17251.56,17251.56,17251.56,24,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,143.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,143.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,147.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,9383.62,9383.62,9383.62,24,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,5971.39,5908.96,6024.71,60,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,143.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,299.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,151.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,143.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,151.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.96,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,146.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,42.96,448,,facility
PURAPLY AM 1 SQ CM,Q4196,HCPCS,636,RC,,,,outpatient,,,254,25.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,126.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,126.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,130.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,126.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,264.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,134.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,126.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,134.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,129.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,126.52,448,,facility
PSYCHOTHERAPY; 1 HOUR,90837,CPT,0914,RC,,,,outpatient,,,499,49.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,140.97,140.97,152.83,102,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,169.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,169.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,174.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,169.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,355.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,180.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,169.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,180.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,173.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,169.87,448,,professional
DRUG TEST PRSMV CHEM ANLYZR,80307,CPT,301,RC,,,,outpatient,,,251,25.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,55.27,55.27,55.27,34,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,62.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,62.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,171.87,131.38,223.26,14,percent of total billed charges,,,33.6,,206.45,131.38,223.26,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,131.38,102.04,131.38,13,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,62.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,129.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,65.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,55.27,55.27,55.27,332,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,62.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,65.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,125.7,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,63.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,62.14,448,,facility
TRG GENE REARRANGEMENT ANAL,81342,CPT,310,RC,,,,outpatient,,,485,48.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,179.23,179.23,179.23,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,201.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,201.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,207.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,201.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,421.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,213.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,201.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,213.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,435.33,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,205.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,201.5,448,,facility
UNLISTED MOLECULAR PATHOLOGY,81479,CPT,310,RC,,,,outpatient,,,4631,463.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,561.56,561.56,561.56,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,32.5,32.5,3071.5,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
COAGULATION ASSESSMENT BLOOD TEST; SUBSTITUTION; PLASMA FRACTIONS,85732,CPT,0305,RC,,,,outpatient,,,159,15.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.75,5.75,5.75,18,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,24.29,15.46,83.95,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,15.46,15.46,15.46,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,13.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.75,5.75,5.75,33,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.97,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,6.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,6.47,448,,facility
ASSAY OF THYROGLOBULIN,84432,CPT,301,RC,,,,outpatient,,,166,16.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,14.29,14.29,14.29,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,5.9,5.9,33.04,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,5.28,3.36,29.57,1 through 10,percent of total billed charges,,,33.6,,14.58,14.58,18.82,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,14.58,3.36,18.82,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,33.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,14.29,10,14.29,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,34.7,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,16.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,16.06,448,,facility
MICRODISSECTION MANUAL,88381,CPT,310,RC,,,,outpatient,,,3623,362.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,93.74,93.74,93.74,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,21.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,44.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,21.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,172.62,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,21.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,21.51,448,,facility
X-RAY OF ELBOW; 2 VIEWS,73070,CPT,0320,RC,,,,outpatient,,,819,81.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,85.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,174.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,17.25,17.25,17.75,92,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,84.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,83.29,448,,facility
BLOOD SODIUM LEVEL,84295,CPT,0301,RC,,,,outpatient,,,49,4.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.28,4.28,4.28,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,9.62,9.62,9.62,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,36.54,21.5,36.54,1 through 10,percent of total billed charges,,,33.6,,21.5,21.5,21.5,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,21.5,16.47,43.01,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,10.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.28,4.28,4.28,39,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.4,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,4.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,4.81,448,,facility
BIOPSY OF RECTUM,45100,CPT,750,RC,,,,outpatient,,,11563,1156.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,2656.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2656.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2736.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2656.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,5552.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2815.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2656.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2815.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3821,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,2709.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,5552.02,,facility
DXA BONE DENSITY MEASUREMENT OF HIP; PELVIS; SPINE INCLUDING SPINE FRACTURE ASSESSMENT,77085,CPT,0320,RC,,,,outpatient,,,322,32.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,448,,facility
ANALYSIS FOR ANTIBODY TO CANDIDA (YEAST),86628,CPT,0302,RC,,,,outpatient,,,87,8.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.94,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.01,448,,facility
HEXAGNAL PHOSPH PLTLT NEUTRL,85598,CPT,305,RC,,,,outpatient,,,267,26.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.99,15.99,15.99,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,168.32,168.32,168.32,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,37.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.98,448,,facility
HEMOGLOBIN ANALYSIS AND MEASUREMENT; CHROMATOGRAPHY,83021,CPT,0301,RC,,,,outpatient,,,190,19,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.06,16.06,16.06,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,37.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,58.38,58.38,58.38,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.06,16.06,16.06,16,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,39.01,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.06,448,,facility
BODY FLUID SPECIFIC GRAVITY,84315,CPT,301,RC,,,,outpatient,,,166,16.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,6.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.74,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,3.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,3.28,448,,facility
ANGIOTENSIN LL (PROTEIN) LEVEL,82163,CPT,0301,RC,,,,outpatient,,,228,22.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,20.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,42.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,21.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,20.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,21.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,44.35,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,20.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,20.52,448,,facility
5% DEXTROSE/WATER,J7060,HCPCS,636,RC,,,,outpatient,,,14,1.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,4.36,4.36,4.36,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",448,448,,facility
MULTI-DUROMETER BELOW KNEE,L5665,HCPCS,274,RC,,,,outpatient,,,985,98.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,66,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,61,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,669.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,669.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,690.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,669.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1400.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,710.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,710.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,683.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,669.92,1400.13,,facility
ASSAY OF URINE CREATININE,82570,CPT,301,RC,,,,outpatient,,,117,11.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.61,4.61,4.61,213,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,71.39,41.89,142.78,14,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,37.49,23.86,74.98,60,percent of total billed charges,,,33.6,,37.49,23.85,81.31,18,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,24.07,23.86,47.71,75,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,10.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,60.5,4.61,151,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,14.91,14.91,25.41,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,85.58,85.58,85.58,1 through 10,percent of total billed charges,,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.61,4.61,4.61,636,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.18,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.18,448,,facility
X-RAY OF HIP; 1 VIEW,73501,CPT,0320,RC,,,,outpatient,,,914,91.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,85.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,174.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.68,19.68,19.68,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,84.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,83.29,448,,facility
ZIKA VIRUS IGM ANTIBODY,86794,CPT,302,RC,,,,outpatient,,,353,35.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,35.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.4,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,16.85,448,,facility
IMMUNOASSAY QUANT NOS NONAB,83520,CPT,301,RC,,,,outpatient,,,411,41.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,36,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,66.08,66.08,66.08,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,41.18,24.82,318.38,1 through 10,percent of total billed charges,,,33.6,,37.63,37.63,96.43,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,33.6,23.18,176.4,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,36.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,87,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.22,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.27,448,,facility
QUANTITATIVE ASSAY DRUG,80299,CPT,301,RC,,,,outpatient,,,187,18.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,13,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,174.64,174.64,174.64,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,171.6,171.6,171.6,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,374.52,374.52,374.52,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.62,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.64,448,,facility
STUDY OF RECTUM SENSITIVITY AND FUNCTION,91122,CPT,0750,RC,,,,outpatient,,,4315,431.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 103.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment.",,,,0,other,"Payer contract is 103.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment. + No services performed during 15-month lookback period",,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment. + No services performed during 15-month lookback period",,,"Payer contract is 209.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment.",,,,0,other,"Payer contract is 209.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment. + No services performed during 15-month lookback period",,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment. + No services performed during 15-month lookback period",,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,150.77,150.77,158.22,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2440,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,"Payer contract is 102.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment.",302.13,302.13,302.13,1 through 10,other,"Payer contract is 102.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment.",448,2440,,facility
DRUG TEST PRSMV CHEM ANLYZR,80307,CPT,301,RC,,,,outpatient,,,700,70,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,55.27,55.27,55.27,34,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,62.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,62.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,171.87,131.38,223.26,14,percent of total billed charges,,,33.6,,206.45,131.38,223.26,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,131.38,102.04,131.38,13,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,62.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,129.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,65.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,55.27,55.27,55.27,332,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,62.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,65.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,125.7,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,63.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,62.14,448,,facility
SLEEP STUDY IN SLEEP LAB (6 YEARS OR OLDER),95810,CPT,0740,RC,,,,outpatient,,,10758,1075.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,892.66,758.08,892.66,77,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,6885.12,6885.12,6885.12,11,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,821.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,821.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,846.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,5680.22,5680.22,5680.22,1 through 10,percent of total billed charges,,,33.6,,5680.22,3646.96,5680.22,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,3646.96,3614.69,3646.96,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,821.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1717.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,871.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,413.57,413.57,423.13,91,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,821.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,871.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1175,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,838.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1717.69,,facility
RIA NONANTIBODY,83519,CPT,301,RC,,,,outpatient,,,90,9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,55.44,55.44,55.44,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.37,16.37,16.37,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.2,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.4,448,,facility
DETECT AGENT NOS DNA AMP,87798,CPT,306,RC,,,,outpatient,,,885,88.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,110.88,110.88,174.24,1 through 10,percent of total billed charges,,,33.6,,244.27,244.27,244.27,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,96.77,32.38,119.79,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,38.9,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
PROTEIN WESTERN BLOT TEST,84182,CPT,301,RC,,,,outpatient,,,593,59.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,217.54,217.54,217.54,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,29.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,61.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,30.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,25.98,25.98,25.98,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,29.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,30.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,51.12,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,29.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,29.21,448,,facility
SPECIAL STAINED SPECIMEN SLIDES TO EXAMINE TISSUE; INITIAL PROCEDURE,88342,CPT,0310,RC,,,,outpatient,,,644,64.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,150.35,150.35,163,21,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,412.16,68.86,412.16,25,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,379.96,379.96,379.96,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,167.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,289.16,216.38,432.77,28,percent of total billed charges,,,33.6,,216.38,43.79,340.03,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,216.38,216.38,218.32,28,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,340.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,172.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,322,322,644,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,63.66,60.24,63.66,181,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,172.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,377,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,166.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,163.06,448,,facility
AMINO ACIDS QUAN 6 OR MORE,82139,CPT,301,RC,,,,outpatient,,,328,32.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.01,12,15.01,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,230.18,110.21,262.42,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,35.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,164.01,164.01,164.01,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.01,12,15.01,16,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.45,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,16.87,448,,facility
LSO FLEX NO RI STAYS PRE OTS,L0628,HCPCS,274,RC,,,,outpatient,,,155,15.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,66,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,61,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,61.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,61.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,63.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,61.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,128.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,65.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,61.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,65.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,62.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,61.45,128.43,,facility
FACTOR INHIBITOR TEST,85335,CPT,305,RC,,,,outpatient,,,500,50,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.45,11.45,11.45,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,598.85,598.85,598.85,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,26.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.45,11.45,11.45,14,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.81,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.87,448,,facility
TARGETED GENOMIC SEQUENCE ANALYSIS PANEL; HEMATOLYMPHOID NEOPLASM OR DISORDER; 5-50 GENES (EG; BRAF; CEBPA; DNMT3A; EZH2; FLT3; IDH1; IDH2; JAK2; KIT; KRAS; MLL; NOTCH1; NPM1; NRAS); INTERROGATION FOR SEQUENCE VARIANTS; AND COPY NUMBER VARIANTS OR REARRANGEMENTS; OR ISOFORM EXPRESSION OR MRNA EXPRESSION LEVELS; IF PERFORMED; RNA ANALYSIS,81451,CPT,0310,RC,,,,outpatient,,,2920,292,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,759.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,759.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,782.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,759.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1587.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,805.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,759.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,805.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1329.18,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,774.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1587.42,,facility
SMEAR SPECIAL STAIN,87207,CPT,306,RC,,,,outpatient,,,67,6.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,39.53,39.53,574.66,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,12.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.95,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,6.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.99,448,,facility
CLOSED TREATMENT OF DISLOCATED HIP PROSTHESIS,27265,CPT,0450,RC,,,,outpatient,,,2910,291,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,243.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,493.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,240.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,236.08,1173,,facility
COL CHROMOTOGRAPHY QUAL/QUAN,82542,CPT,301,RC,,,,outpatient,,,1227,122.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,21.43,21.43,21.43,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,435.07,435.07,435.07,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,24.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,50.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,25.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,21.43,21.43,21.43,15,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,24.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,25.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.16,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,24.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,24.09,448,,facility
DRESSING CHANGE OR REMOVAL OF BURN TISSUE; LESS THAN 5% OF TOTAL BODY SURFACE,16020,CPT,0450,RC,,,,outpatient,,,401,40.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,197.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,175.06,175.06,297.49,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,175.06,175.06,175.06,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,401.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,203.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,203.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,195.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,192.01,1173,,facility
REMOVAL OF FOREIGN BODY IN CORNEA USING SLIT LAMP,65222,CPT,0450,RC,,,,outpatient,,,3201,320.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,131.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,266.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,134.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,114.79,114.79,119.81,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,127.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,134.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,129.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,127.33,448,,facility
ASSAY OF CERULOPLASMIN,82390,CPT,301,RC,,,,outpatient,,,263,26.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9.55,9.55,9.55,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,21.65,21.65,21.65,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,13.78,13.78,13.9,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,22.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9.55,9.55,9.55,44,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,23.21,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,10.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,10.74,448,,facility
REMOVAL OF FOREIGN BODY OF FOOT TISSUE; DEEP,28192,CPT,0361,RC,,,,outpatient,,,3925,392.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1628.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3303.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1675.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1675.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3821,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1612.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3821,,facility
IMMUNOASSAY NONANTIBODY,83516,CPT,301,RC,,,,outpatient,,,94,9.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9,9,10.26,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,4.75,4.75,218.59,30,percent of total billed charges,,,33.6,,3.02,3.02,175.39,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,3.02,3.02,211.68,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,24.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,23.5,23.5,23.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9,9,10.26,51,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.92,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,11.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.53,448,,facility
INTMD RPR S/TR/EXT >30.0 CM,12037,CPT,450,RC,,,,outpatient,,,5264,526.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1974.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1974.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2033.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1974.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,4127.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2093.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1974.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2093.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2014.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,4127.08,,facility
ASSAY OF COPPER,82525,CPT,301,RC,,,,outpatient,,,1049,104.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.04,11.04,11.04,18,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,35.64,22.85,35.9,1 through 10,percent of total billed charges,,,33.6,,80.64,80.64,80.64,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,22.85,19.49,22.85,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,50.4,50.4,50.4,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.04,11.04,11.04,37,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.81,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.41,448,,facility
ASSAY OF URINE CREATININE,82570,CPT,301,RC,,,,outpatient,,,302,30.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.61,4.61,4.61,213,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,71.39,41.89,142.78,14,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,37.49,23.86,74.98,60,percent of total billed charges,,,33.6,,37.49,23.85,81.31,18,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,24.07,23.86,47.71,75,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,10.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,60.5,4.61,151,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,14.91,14.91,25.41,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,85.58,85.58,85.58,1 through 10,percent of total billed charges,,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.61,4.61,4.61,636,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.18,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.18,448,,facility
ANTINUCLEAR ANTIBODIES,86038,CPT,302,RC,,,,outpatient,,,251,25.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.75,10.75,10.75,34,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,148.09,148.09,148.09,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,84.34,29.04,132.53,14,percent of total billed charges,,,33.6,,84.34,18.48,127.78,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,84.34,84.34,85.09,12,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,11.55,11.55,11.55,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.75,10.75,10.75,126,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.11,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.09,448,,facility
HEP B SURFACE ANTIBODY,86706,CPT,302,RC,,,,outpatient,,,46,4.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,33.73,33.73,33.73,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,22.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9.55,9.55,9.55,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,23.21,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,10.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,10.74,448,,facility
CHORIONIC GONADOTROPIN ASSAY,84703,CPT,301,RC,,,,outpatient,,,37,3.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,6.69,6.69,6.69,19,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,23.68,23.68,102.4,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,91.36,19.54,91.36,38,percent of total billed charges,,,33.6,,53.76,49.73,91.36,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,53.76,41.7,53.76,24,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,7.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,15.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,7.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,6.69,6.69,6.69,323,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,7.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,7.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.26,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,7.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,7.52,448,,facility
OPIATES 1 OR MORE,80361,CPT,301,RC,,,,outpatient,,,178,17.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
INSERTION OF TUBE IN CORONARY ARTERY FOR DIAGNOSIS WITH REVIEW BY RADIOLOGIST,93454,CPT,0480,RC,,,,outpatient,,,21723,2172.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2004,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,2759,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 6500.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 10000.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,3102.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3102.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3195.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,8276.46,8276.46,8276.46,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3102.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,6484.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3288.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3102.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3288.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1463,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,3164.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,1463,6484.66,,facility
QUANTITATIVE ASSAY DRUG,80299,CPT,301,RC,,,,outpatient,,,225,22.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,13,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,174.64,174.64,174.64,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,171.6,171.6,171.6,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,374.52,374.52,374.52,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.62,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.64,448,,facility
DETECTION TEST BY IMMUNOASSAY TECHNIQUE FOR OTHER ORGANISM,87449,CPT,0306,RC,,,,outpatient,,,375,37.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,198,198,198,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,26.27,26.27,26.27,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.66,10.66,10.66,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.9,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.98,448,,facility
AMPHETAMINES 5 OR MORE,80326,CPT,301,RC,,,,outpatient,,,35,3.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
UNLISTED MOLECULAR PATHOLOGY,81479,CPT,310,RC,,,,outpatient,,,1547,154.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,561.56,561.56,561.56,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,32.5,32.5,3071.5,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
SO NEO GSAP 5-50DNA/DNA&RNA,81445,CPT,310,RC,,,,outpatient,,,5000,500,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,597.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,597.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,615.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,597.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1249.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,633.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,597.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,633.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1046.34,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,609.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1249.63,,facility
ASSAY OF URINE POTASSIUM,84133,CPT,301,RC,,,,outpatient,,,19,1.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.21,4.21,4.21,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,22.51,22.51,22.71,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,9.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,9.5,9.5,33.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.21,4.21,4.21,20,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.31,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,4.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,4.73,448,,facility
NEEDLE BIOPSY OR REMOVAL OF SURFACE LYMPH NODES,38505,CPT,0360,RC,,,,outpatient,,,2665,266.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1628.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,989.52,989.52,989.52,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3303.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1675.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1675.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3821,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1612.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3821,,facility
COL CHROMOTOGRAPHY QUAL/QUAN,82542,CPT,301,RC,,,,outpatient,,,132,13.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,21.43,21.43,21.43,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,435.07,435.07,435.07,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,24.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,50.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,25.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,21.43,21.43,21.43,15,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,24.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,25.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.16,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,24.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,24.09,448,,facility
ASSAY OF CRYOGLOBULIN,82595,CPT,301,RC,,,,outpatient,,,254,25.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.75,5.75,5.75,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,38.54,38.54,38.54,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,13.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.75,5.75,5.75,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.97,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,6.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,6.47,448,,facility
KNE-SHIN EXO SNG AXI MNL LOC,L5710,HCPCS,274,RC,,,,outpatient,,,772,77.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,66,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,61,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,523.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,523.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,539.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,523.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1095.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,555.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,523.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,555.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,534.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,523.99,1095.14,,facility
MLH1 GENE,81288,CPT,310,RC,,,,outpatient,,,610,61,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,192.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,192.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,198.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,192.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,401.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,203.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,192.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,203.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,336.56,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,196.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,192.32,448,,facility
QUANTITATIVE ASSAY DRUG,80299,CPT,301,RC,,,,outpatient,,,78,7.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,13,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,174.64,174.64,174.64,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,171.6,171.6,171.6,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,374.52,374.52,374.52,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.62,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.64,448,,facility
FLOW CYTOMETRY TECHNIQUE FOR DNA OR CELL ANALYSIS; FIRST MARKER,88184,CPT,0311,RC,,,,outpatient,,,1143,114.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,315.62,315.62,343.05,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,546.56,546.56,731.52,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,343.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,343.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,353.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,286.94,286.94,384.05,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,343.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,716.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,363.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,179.34,179.34,179.34,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,63.07,63.07,165.15,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,343.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,363.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,377,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,349.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,343.05,716.97,,facility
"INJ., DURVALUMAB, 10 MG",J9173,HCPCS,636,RC,,,,outpatient,,,339,33.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,87.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,87.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,90.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,87.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,183.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,93.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,87.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,93.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,180.34,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,89.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,87.95,448,,facility
ASSAY OF URINE/UREA-N,84540,CPT,301,RC,,,,outpatient,,,94,9.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,91.87,91.87,91.87,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,11.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,135.5,135.5,135.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.95,4.95,4.95,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.26,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.56,448,,facility
MICROSOMAL ANTIBODIES (AUTOANTIBODY) MEASUREMENT,86376,CPT,0302,RC,,,,outpatient,,,67.25,6.73,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.94,12.94,12.94,22,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,22.18,14.11,82.9,1 through 10,percent of total billed charges,,,33.6,,22.51,22.51,22.51,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,22.51,11.27,81.98,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,30.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.94,12.94,12.94,63,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,31.43,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.55,448,,facility
DNA/RNA SEQUENCING,87153,CPT,306,RC,,,,outpatient,,,357,35.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,102.61,102.61,102.61,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,115.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,115.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,118.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,385.39,385.39,385.39,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,115.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,241.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,122.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,115.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,122.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,249.24,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,117.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,115.36,448,,facility
ULTRASOUND SCAN OF PREGNANT UTERUS (LESS THAN 14 WEEKS); SINGLE OR FIRST FETUS,76801,CPT,0402,RC,,,,outpatient,,,1151,115.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,93.3,92.3,100.06,80,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,675.49,397.49,675.49,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,248.43,248.43,248.43,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,56.37,56.37,59.13,54,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,465,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,465,,facility
GUIDANCE FOR RADJ TX DLVR,77387,CPT,333,RC,,,,outpatient,,,2529,252.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,34.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,34.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,34.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,72.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,36.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,34.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,36.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,48815,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,34.82,48815,,facility
NK CELLS TOTAL COUNT,86357,CPT,302,RC,,,,outpatient,,,558,55.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,33.56,33.56,33.56,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,60.77,60.77,60.77,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,37.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,37.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,27.98,27.98,27.98,1 through 10,percent of total billed charges,,,33.6,,33.56,33.56,33.56,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,537.59,537.59,537.59,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,78.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,39.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,33.56,33.56,33.56,25,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,39.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,81.52,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,38.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,37.73,448,,facility
METHYLPHENIDATE,80360,CPT,301,RC,,,,outpatient,,,35,3.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
REPLACEMENT OF STOMACH STOMA TUBE,43762,CPT,0450,RC,,,,outpatient,,,1102,110.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,213.4,213.4,220.56,23,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,239.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,239.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,246.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,239.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,499.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,253.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,224.99,224.99,224.99,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,239.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,253.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,243.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,239.12,1173,,facility
MEASUREMENT OF ITRACONAZOLE,80189,CPT,0301,RC,,,,outpatient,,,1049,104.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,24.11,24.11,24.11,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,27.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,56.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,28.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,27.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,28.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,47.44,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,27.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,27.11,448,,facility
GENE ANALYSIS (COAGULATION FACTOR V) LEIDEN VARIANT,81241,CPT,0310,RC,,,,outpatient,,,653,65.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,65.26,65.26,65.26,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,73.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,73.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,219.41,219.41,219.41,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,73.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,153.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,77.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,65.26,65.26,65.26,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,73.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,77.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,132.02,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,74.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,73.37,448,,facility
GENOME SEQUENCE ANALYSIS,81426,CPT,310,RC,,,,outpatient,,,5638,563.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2709.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2709.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2791.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2709.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,5663.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2872.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2709.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2872.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4742.41,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,2764.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,5663.8,,facility
ANALYSIS FOR ANTIBODY TO COXIELLA BURNETII (Q FEVER BACTERIA),86638,CPT,0302,RC,,,,outpatient,,,67.65,6.77,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.2,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.12,448,,facility
AFFINITY1 SQUARE CM,Q4159,HCPCS,636,RC,,,,outpatient,,,1091,109.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,126.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,126.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,130.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,126.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,264.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,134.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,126.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,134.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,129.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,126.52,448,,facility
ANALYSIS FOR ANTIBODY TO EPSTEIN-BARR VIRUS (MONONUCLEOSIS VIRUS); NUCLEAR ANTIGEN,86664,CPT,0302,RC,,,,outpatient,,,213,21.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.6,13.6,13.6,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,49.92,22.4,49.92,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,41.18,41.18,41.18,1 through 10,percent of total billed charges,,,33.6,,71.57,71.57,71.57,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,28.56,28.56,71.57,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,31.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.6,13.6,13.6,15,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,33.04,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,15.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,15.29,448,,facility
UNLISTED MOLECULAR PATHOLOGY,81479,CPT,310,RC,,,,outpatient,,,1360,136,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,561.56,561.56,561.56,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,32.5,32.5,3071.5,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
SC STD DISK METHOD PER PLATE,87184,CPT,306,RC,,,,outpatient,,,328,32.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,7.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,15.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,7.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,6.65,6.65,6.65,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,7.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,7.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.89,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,7.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,7.48,448,,facility
F5 GENE,81241,CPT,310,RC,,,,outpatient,,,260,26,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,65.26,65.26,65.26,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,73.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,73.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,219.41,219.41,219.41,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,73.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,153.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,77.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,65.26,65.26,65.26,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,73.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,77.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,132.02,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,74.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,73.37,448,,facility
INJ MVASI 10 MG,Q5107,HCPCS,636,RC,,,,outpatient,,,249,24.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,5258.88,5258.88,5258.88,198,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,24.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,5570.26,5570.26,5570.26,180,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,2633.91,2560.07,7525.25,438,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,24.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,51.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,24.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,61.77,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,25.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,24.53,448,,facility
CARDIOLIPIN ANTIBODY EA IG,86147,CPT,302,RC,,,,outpatient,,,197,19.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,22.64,22.64,22.64,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,72.86,42.34,163.68,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,50.06,50.06,137.76,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,25.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,53.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,26.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,22.64,22.64,22.64,31,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,25.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,26.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,54.99,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,25.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,25.45,448,,facility
BLOOD VISCOSITY EXAMINATION,85810,CPT,305,RC,,,,outpatient,,,230,23,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,24.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.22,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,11.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.67,448,,facility
ASSAY OF UREA NITROGEN,84520,CPT,301,RC,,,,outpatient,,,19,1.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.51,3.51,3.51,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,7.9,7.9,7.9,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,37.69,22.18,37.69,1 through 10,percent of total billed charges,,,33.6,,22.18,22.18,22.18,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,22.18,19.49,43.73,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,8.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.51,3.51,3.51,46,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.54,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,4.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,3.95,448,,facility
ENCEPHALTIS ST LOUIS ANTBODY,86653,CPT,302,RC,,,,outpatient,,,52,5.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.49,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.19,448,,facility
HEMOGLOBIN ELECTROPHORESIS,83020,CPT,301,RC,,,,outpatient,,,549,54.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.45,11.45,11.45,22,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,12.1,12.1,12.29,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,26.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,18,18,18,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,29.19,29.19,29.19,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.45,11.45,11.45,47,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.81,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.87,448,,facility
TRANSFERRIN (IRON BINDING PROTEIN) LEVEL,84466,CPT,0301,RC,,,,outpatient,,,412,41.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.35,11.35,11.35,19,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,63.57,63.57,63.57,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,57.02,36.29,217.54,41,percent of total billed charges,,,33.6,,36.29,36.29,217.54,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,36.53,36.29,138.43,42,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,26.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,54,53.88,54,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.35,11.35,11.35,63,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.58,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.76,448,,facility
IMMUNOASSAY NONANTIBODY,83516,CPT,301,RC,,,,outpatient,,,780,78,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9,9,10.26,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,4.75,4.75,218.59,30,percent of total billed charges,,,33.6,,3.02,3.02,175.39,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,3.02,3.02,211.68,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,24.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,23.5,23.5,23.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9,9,10.26,51,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.92,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,11.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.53,448,,facility
DRUG SCREEN QUAN LAMOTRIGINE,80175,CPT,301,RC,,,,outpatient,,,59,5.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.79,11.79,11.79,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,31.15,31.15,57.67,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,29.5,29.5,29.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.79,11.79,11.79,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.63,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.25,448,,facility
MASSAGE OF HEART MUSCLE THROUGH CHEST,32160,CPT,0450,RC,,,,outpatient,,,2393,239.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,723.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,723.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,744.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,723.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1511.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,766.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,723.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,766.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,737.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1511.55,,facility
SMN1 GENE DOS/DELETION ALYS,81329,CPT,310,RC,,,,outpatient,,,305,30.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,121.86,121.86,121.86,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,137,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,137,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,141.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,471.5,471.5,471.5,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,300.05,300.05,302.73,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,137,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,286.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,145.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,121.86,121.86,121.86,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,137,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,145.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,239.75,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,139.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,137,448,,facility
ASSAY OF CHLORAMPHENICOL,82415,CPT,301,RC,,,,outpatient,,,96,9.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,26.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.37,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.67,448,,facility
ANTINUCLEAR ANTIBODIES,86038,CPT,302,RC,,,,outpatient,,,230,23,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.75,10.75,10.75,34,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,148.09,148.09,148.09,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,84.34,29.04,132.53,14,percent of total billed charges,,,33.6,,84.34,18.48,127.78,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,84.34,84.34,85.09,12,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,11.55,11.55,11.55,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.75,10.75,10.75,126,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.11,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.09,448,,facility
ESTABLISHED PATIENT PERIODIC PREVENTIVE MEDICINE EXAMINATION (18-39 YEARS),99395,CPT,0770,RC,,,,outpatient,,,462,46.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,74.57,74.57,74.57,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
UNLISTED MOLECULAR PATHOLOGY,81479,CPT,310,RC,,,,outpatient,,,7101,710.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,561.56,561.56,561.56,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,32.5,32.5,3071.5,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
X-RAY EXAM OF KNEE 3,73562,CPT,320,RC,,,,outpatient,,,1841,184.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,85.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,174.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,25.61,25.61,26.63,56,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,84.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,83.29,448,,facility
RABIES VACCINE ID,90676,CPT,636,RC,,,,outpatient,,,1034,103.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,236.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,243.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,236.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,495.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,251.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,236.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,251.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,568.61,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,241.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,236.86,568.61,,facility
THYROID STIMULATING IMMUNE GLOBULINS (THYROID RELATED PROTEIN) LEVEL,84445,CPT,0301,RC,,,,outpatient,,,138.5,13.85,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,45.24,45.24,45.24,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,342.79,342.79,342.79,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,50.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,50.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,52.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,73.39,46.7,306.77,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,46.95,46.95,195.22,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,50.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,106.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,53.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,45.24,45.24,45.24,18,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,50.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,53.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,109.87,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,51.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,50.86,448,,facility
DRUG SCREENING OXYCODONE,80365,CPT,301,RC,,,,outpatient,,,394,39.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
QUANTITATIVE ASSAY DRUG,80299,CPT,301,RC,,,,outpatient,,,462,46.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,13,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,174.64,174.64,174.64,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,171.6,171.6,171.6,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,374.52,374.52,374.52,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.62,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.64,448,,facility
DRUG SCREENING OXYCODONE,80365,CPT,301,RC,,,,outpatient,,,35,3.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
OT EVAL LOW COMPLEX 30 MIN,97165,CPT,434,RC,,,,outpatient,,,637,63.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,51.96,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,89.84,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,80,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,95.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,95.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,98.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,95.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,199.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,95.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,422,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,97.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,51.96,448,,facility
PROGRAMMING OF CARDIAC RHYTHM MONITOR SYSTEM,93285,CPT,0920,RC,,,,outpatient,,,171.5,17.15,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,74.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,422,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,36.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.71,448,,facility
F2 GENE,81240,CPT,310,RC,,,,outpatient,,,260,26,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,58.43,58.43,58.43,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,65.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,65.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,67.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,137.28,137.28,137.28,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,219.41,219.41,219.41,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,65.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,137.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,69.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,58.43,58.43,58.43,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,65.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,69.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,114.96,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,65.69,448,,facility
MENACWYD/MENACWYCRM VACC IM,90734,CPT,636,RC,,,,outpatient,,,367,36.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,235.14,235.14,235.14,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,138.57,138.57,138.57,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
MASS SPECTROMETRY QUAL/QUAN,83789,CPT,301,RC,,,,outpatient,,,2973,297.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,24.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,50.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,25.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,24.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,25.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.19,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,24.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,24.11,448,,facility
HEPARIN NEUTRALIZATION,85525,CPT,305,RC,,,,outpatient,,,197,19.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,24.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.59,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.84,448,,facility
CARDIOLIPIN ANTIBODY EA IG,86147,CPT,302,RC,,,,outpatient,,,407,40.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,22.64,22.64,22.64,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,72.86,42.34,163.68,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,50.06,50.06,137.76,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,25.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,53.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,26.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,22.64,22.64,22.64,31,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,25.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,26.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,54.99,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,25.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,25.45,448,,facility
BRAF GENE,81210,CPT,310,RC,,,,outpatient,,,1197,119.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,156.02,156.02,156.02,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,175.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,175.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,180.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,175.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,366.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,185.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,156.02,156.02,156.02,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,175.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,185.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,306.95,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,178.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,175.4,448,,facility
QUANTITATIVE ASSAY DRUG,80299,CPT,301,RC,,,,outpatient,,,172,17.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,13,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,174.64,174.64,174.64,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,171.6,171.6,171.6,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,374.52,374.52,374.52,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.62,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.64,448,,facility
FLUORESCENT ANTIBODY SCREEN,86255,CPT,302,RC,,,,outpatient,,,1446,144.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.72,10.72,10.72,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,45.41,28.9,1068.67,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,28.9,28.9,28.9,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.72,10.72,10.72,19,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.04,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.05,448,,facility
REPAIR OF WOUND OF SCALP; ARMS; OR LEGS BY TRANSFERRING SKIN; 10.1-30.0 SQ CM,14021,CPT,0761,RC,,,,outpatient,,,3201,320.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1027,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1519,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1974.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1974.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2033.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1974.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,4127.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2093.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1974.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2093.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,2014.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,4127.08,,facility
REMOVAL OF FOREIGN BODY IN CORNEA,65220,CPT,0450,RC,,,,outpatient,,,3201,320.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,427.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,427.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,440.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,427.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,893.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,453.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,427.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,453.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,436.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,427.54,893.56,,facility
SPECTROPHOTOMETRY,84311,CPT,301,RC,,,,outpatient,,,405,40.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,7.2,7.2,7.2,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,45.35,45.35,53.33,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,16.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,7.2,7.2,7.2,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.1,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,8.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,8.1,448,,facility
TUBERCULOSIS TEST; GAMMA INTERFERON,86480,CPT,0302,RC,,,,outpatient,,,110,11,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,55.13,55.13,55.13,82,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,64.9,45.87,225.38,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,61.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,61.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,63.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,58.08,58.08,201.7,24,percent of total billed charges,,,33.6,,58.08,36.96,58.08,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,36.96,36.96,99.67,22,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,61.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,129.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,65.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,55,55,55,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,55.13,55.13,55.13,131,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,61.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,65.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,133.91,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,63.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,61.98,448,,facility
IDENTIFICATION OF ORGANISMS BY NUCLEIC ACID SEQUENCING METHOD,87153,CPT,0306,RC,,,,outpatient,,,935,93.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,102.61,102.61,102.61,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,115.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,115.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,118.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,385.39,385.39,385.39,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,115.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,241.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,122.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,115.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,122.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,249.24,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,117.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,115.36,448,,facility
DRUG SCREEN QUANT TIAGABINE,80199,CPT,301,RC,,,,outpatient,,,85,8.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,27.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,56.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,28.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,27.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,28.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,47.44,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,27.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,27.11,448,,facility
CYTOGENETICS 100-300,88275,CPT,311,RC,,,,outpatient,,,1056,105.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,45.53,45.53,45.53,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,51.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,51.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,52.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,1828.51,1828.51,1828.51,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,401.18,401.18,401.18,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,51.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,106.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,54.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,45.53,45.53,45.53,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,51.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,54.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,89.58,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,52.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,51.19,448,,facility
PACLITAXEL PROTEIN BOUND,J9264,HCPCS,636,RC,,,,outpatient,,,61,6.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,20838.21,20838.21,20838.21,946,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,6.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,13.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.11,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,6.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,6.59,448,,facility
HEP B CORE ANTIBODY TOTAL,86704,CPT,302,RC,,,,outpatient,,,46,4.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.72,10.72,10.72,67,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,71.68,71.68,83.84,35,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,66.08,66.08,66.08,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,59.14,37.63,59.14,29,percent of total billed charges,,,33.6,,59.14,37.63,59.14,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,37.63,37.63,37.97,41,percent of total billed charges,,,34.6,,38.48,13.53,47.55,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,56,56,56,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.72,10.72,10.72,161,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.04,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.05,448,,facility
ASSAY OF THYROGLOBULIN,84432,CPT,301,RC,,,,outpatient,,,163,16.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,14.29,14.29,14.29,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,5.9,5.9,33.04,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,5.28,3.36,29.57,1 through 10,percent of total billed charges,,,33.6,,14.58,14.58,18.82,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,14.58,3.36,18.82,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,33.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,14.29,10,14.29,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,34.7,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,16.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,16.06,448,,facility
ENZYME CELL ACTIVITY,82657,CPT,301,RC,,,,outpatient,,,1166,116.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.72,19.72,19.72,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,2094.14,2094.14,2094.14,1 through 10,percent of total billed charges,,,33.6,,762.96,762.96,762.96,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,46.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,23.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.72,19.72,19.72,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,23.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,39.01,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,22.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,22.17,448,,facility
VIRUS INOCULATE TISSUE ADDL,87253,CPT,306,RC,,,,outpatient,,,938,93.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,20.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,42.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,21.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,20.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,21.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,43.65,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,20.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,20.2,448,,facility
CYTOGENETICS DNA PROBE,88271,CPT,311,RC,,,,outpatient,,,869,86.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.05,19.05,19.05,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,1274.11,1274.11,1274.11,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,477.79,477.79,477.79,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,21.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,44.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.05,19.05,19.05,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,21.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,46.27,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,21.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,21.42,448,,facility
ASSAY OF QUININE,84228,CPT,301,RC,,,,outpatient,,,324,32.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,24.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.13,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,11.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.63,448,,facility
DRUG ASY HYDROXYCHLOROQUINE,80220,CPT,301,RC,,,,outpatient,,,650,65,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.62,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.64,448,,facility
HBB GENE DUP/DEL VARIANTS,81363,CPT,310,RC,,,,outpatient,,,5038,503.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,202.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,202.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,208.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,202.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,423.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,214.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,202.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,214.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,354.2,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,206.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,202.4,448,,facility
SARSCV2 VAC 10MCG TRS-SUC IM,91319,CPT,636,RC,,,,outpatient,,,421,42.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare OPPS payment and based on reasonable cost. Payment determination is based on final charges.,,,,0,other,Payer contract is 100.00% of Medicare OPPS payment and based on reasonable cost. Payment determination is based on final charges. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare OPPS payment and based on reasonable cost. Payment determination is based on final charges.,,,,0,other,Payer contract is 100.00% of Medicare OPPS payment and based on reasonable cost. Payment determination is based on final charges. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare OPPS payment and based on reasonable cost. Payment determination is based on final charges.,,,,0,other,Payer contract is 103.00% of Medicare OPPS payment and based on reasonable cost. Payment determination is based on final charges. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare OPPS payment and based on reasonable cost. Payment determination is based on final charges.,,,,0,other,Payer contract is 100.00% of Medicare OPPS payment and based on reasonable cost. Payment determination is based on final charges. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare OPPS payment and based on reasonable cost. Payment determination is based on final charges.,,,,0,other,Payer contract is 209.00% of Medicare OPPS payment and based on reasonable cost. Payment determination is based on final charges. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare OPPS payment and based on reasonable cost. Payment determination is based on final charges.,,,,0,other,Payer contract is 106.00% of Medicare OPPS payment and based on reasonable cost. Payment determination is based on final charges. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare OPPS payment and based on reasonable cost. Payment determination is based on final charges.,,,,0,other,Payer contract is 100.00% of Medicare OPPS payment and based on reasonable cost. Payment determination is based on final charges. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare OPPS payment and based on reasonable cost. Payment determination is based on final charges.,,,,0,other,Payer contract is 106.00% of Medicare OPPS payment and based on reasonable cost. Payment determination is based on final charges. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,188.73,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,Payer contract is 102.00% of Medicare OPPS payment and based on reasonable cost. Payment determination is based on final charges.,,,,0,other,Payer contract is 102.00% of Medicare OPPS payment and based on reasonable cost. Payment determination is based on final charges. + No services performed during 15-month lookback period,188.73,448,,facility
BLOOD TYPING SEROLOGIC RH(D),86901,CPT,302,RC,,,,outpatient,,,277,27.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,2.66,2.66,62.15,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,155.76,19.47,155.76,14,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,88.7,17.42,150.74,116,percent of total billed charges,,,33.6,,88.7,17.42,88.7,44,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,88.7,11.09,100.58,78,percent of total billed charges,,,34.6,,97.68,95.83,100.58,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,74.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,132,16.5,132,13,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,55.44,6.93,55.44,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,2.66,2.66,2.66,1 through 10,percent of total billed charges,,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,2.66,2.66,2.66,829,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.46,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,36.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,6.46,448,,facility
VITAMIN D 25 HYDROXY,82306,CPT,301,RC,,,,outpatient,,,245,24.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,26.33,26.33,26.33,345,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,123.9,123.9,399.43,17,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,110.88,70.56,357.46,103,percent of total billed charges,,,33.6,,71.19,70.56,227.47,16,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,70.56,70.56,227.47,175,percent of total billed charges,,,34.6,,257.94,257.94,257.94,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,29.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,61.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,31.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,105,105,338.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,142.17,44.1,142.17,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,26.33,26.33,26.33,1001,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,29.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,31.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,63.96,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,30.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,29.6,448,,facility
REMOVAL OF SKIN AND TISSUE; 20.0 SQ CM OR LESS,11042,CPT,0450,RC,,,,outpatient,,,1470,147,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,350.55,350.55,350.55,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,400.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,545.66,545.66,545.66,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,813.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,412.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,412.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,396.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,389.05,1311,,facility
CYCLOSPORINE LEVEL,80158,CPT,0301,RC,,,,outpatient,,,210.75,21.08,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,254.93,70.9,254.93,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,37.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.06,16.06,16.06,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.99,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.05,448,,facility
BLOOD TEST; BASIC GROUP OF BLOOD CHEMICALS (CALCIUM; IONIZED),80047,CPT,0300,RC,,,,outpatient,,,259,25.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,28.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.03,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.73,448,,facility
KNEE ORTHOSIS; ADJUSTABLE KNEE JOINTS (UNICENTRIC OR POLYCENTRIC); POSITIONAL ORTHOSIS; RIGID SUPPORT; PREFABRICATED; OFF-THE SHELF,L1833,HCPCS,0274,RC,,,,outpatient,,,1143,114.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,66,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,61,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,455.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,455.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,468.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,455.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,951.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,482.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,455.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,482.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,464.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,455.16,951.28,,facility
BK/AK LOCKING MECHANISM,L5671,HCPCS,274,RC,,,,outpatient,,,1045,104.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,66,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,61,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,703.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,703.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,725,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,703.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1471.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,746.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,703.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,746.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,717.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,703.88,1471.11,,facility
DNA ANTIBODY NATIVE,86225,CPT,302,RC,,,,outpatient,,,88,8.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.22,12.22,12.22,16,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,32.21,29.57,46.46,11,percent of total billed charges,,,33.6,,29.57,29.57,29.57,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,29.66,29.57,98.11,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,28.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.22,12.22,12.22,49,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.7,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.74,448,,facility
BIOPSY OR REMOVAL OF NASAL POLYP OR TISSUE USING AN ENDOSCOPE,31237,CPT,0761,RC,,,,outpatient,,,3143,314.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,1513.06,1513.06,1513.06,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1703.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1703.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1754.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1703.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3560.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1805.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,1535.67,1535.67,1535.67,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1703.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1805.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,1737.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3560.23,,facility
INSITU HYBRIDIZATION (FISH),88364,CPT,310,RC,,,,outpatient,,,2568,256.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,31.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,30.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,64.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,32.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,30.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,32.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,171.99,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,31.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,30.73,448,,facility
X-RAY OF TOE; MINIMUM OF 2 VIEWS,73660,CPT,0320,RC,,,,outpatient,,,879,87.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,85.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,174.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,18.33,18.33,19.14,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,84.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,83.29,448,,facility
ULTRASOUND EVALUATION OF HEART BLOOD VESSEL DURING DIAGNOSIS OR TREATMENT; INITIAL VESSEL,93571,CPT,0481,RC,,,,outpatient,,,4739,473.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,87.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,87.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,90.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,87.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,183.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,93.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,87.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,93.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2440,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,89.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,87.81,2440,,facility
CRANIAL LESION SURGERY USING RADIATION OVER MULTIPLE SESSIONS,77373,CPT,0333,RC,,,,outpatient,,,30875,3087.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,1540.65,1485.2,1610.15,11,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,19760,19760,19760,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1711.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1711.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1762.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,10374,10374,10374,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1711.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3576.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1813.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,1563.66,1563.66,1610.15,19,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1711.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1813.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,48815,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1745.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,48815,,facility
KETAMINE AND NORKETAMINE,80357,CPT,301,RC,,,,outpatient,,,35,3.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
"DARATUMUMAB, HYALURONIDASE",J9144,HCPCS,636,RC,,,,outpatient,,,173,17.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,57.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,57.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,58.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,16441.92,16441.92,16441.92,2160,percent of total billed charges,,,33.6,,16441.92,16441.92,16441.92,180,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,57.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,119.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,60.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,57.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,60.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,110.49,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,58.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,57.05,448,,facility
SARSCV2 VAC 30MCG TRS-SUC IM,91320,CPT,636,RC,,,,outpatient,,,396,39.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,157.64,157.64,157.64,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare OPPS payment and based on reasonable cost. Payment determination is based on final charges.,,,,0,other,Payer contract is 100.00% of Medicare OPPS payment and based on reasonable cost. Payment determination is based on final charges. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare OPPS payment and based on reasonable cost. Payment determination is based on final charges.,,,,0,other,Payer contract is 100.00% of Medicare OPPS payment and based on reasonable cost. Payment determination is based on final charges. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare OPPS payment and based on reasonable cost. Payment determination is based on final charges.,,,,0,other,Payer contract is 103.00% of Medicare OPPS payment and based on reasonable cost. Payment determination is based on final charges. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare OPPS payment and based on reasonable cost. Payment determination is based on final charges.,,,,0,other,Payer contract is 100.00% of Medicare OPPS payment and based on reasonable cost. Payment determination is based on final charges. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare OPPS payment and based on reasonable cost. Payment determination is based on final charges.,,,,0,other,Payer contract is 209.00% of Medicare OPPS payment and based on reasonable cost. Payment determination is based on final charges. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare OPPS payment and based on reasonable cost. Payment determination is based on final charges.,,,,0,other,Payer contract is 106.00% of Medicare OPPS payment and based on reasonable cost. Payment determination is based on final charges. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,157.64,145.97,157.64,22,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare OPPS payment and based on reasonable cost. Payment determination is based on final charges.,44.75,44.75,53.06,70,other,Payer contract is 100.00% of Medicare OPPS payment and based on reasonable cost. Payment determination is based on final charges.,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare OPPS payment and based on reasonable cost. Payment determination is based on final charges.,,,,0,other,Payer contract is 106.00% of Medicare OPPS payment and based on reasonable cost. Payment determination is based on final charges. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,335.19,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,Payer contract is 102.00% of Medicare OPPS payment and based on reasonable cost. Payment determination is based on final charges.,45.65,45.65,54.12,73,other,Payer contract is 102.00% of Medicare OPPS payment and based on reasonable cost. Payment determination is based on final charges.,335.19,448,,facility
MITOMYCIN INJECTION,J9280,HCPCS,636,RC,,,,outpatient,,,469,46.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,34.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,34.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,34.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,71.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,36.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,34.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,36.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,99.65,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,34.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,34.11,448,,facility
OTHER CHEMOTHERAPY PROCEDURE,96549,CPT,0331,RC,,,,outpatient,,,158,15.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,44.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,44.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,46.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,83.42,83.42,83.42,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,53.56,53.56,53.56,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,44.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,93.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,47.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,41.09,41.09,41.09,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,44.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,47.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1603,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,45.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,44.82,1603,,facility
ACETYLCHOLN RCPTR BNDNG ANTB,86041,CPT,302,RC,,,,outpatient,,,106,10.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.37,16.37,16.37,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.2,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.4,448,,facility
REVIEW BY RADIOLOGIST OF MAJOR LOWER BODY VEIN IMAGE,75825,CPT,0320,RC,,,,outpatient,,,5925,592.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3021.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3021.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3112.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3021.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,6315.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3203.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3021.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3203.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,3082.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,443,6315.75,,facility
IMMUNOASSAY QUANT NOS NONAB,83520,CPT,301,RC,,,,outpatient,,,367.25,36.73,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,36,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,66.08,66.08,66.08,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,41.18,24.82,318.38,1 through 10,percent of total billed charges,,,33.6,,37.63,37.63,96.43,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,33.6,23.18,176.4,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,36.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,87,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.22,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.27,448,,facility
X-RAY EXAM HIPS BI 3-4 VIEWS,73522,CPT,320,RC,,,,outpatient,,,1188,118.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,448,,facility
INSERTION OF TUBE INTO MIDDLE SMALL BOWEL USING AN ENDOSCOPE,44372,CPT,0750,RC,,,,outpatient,,,8621,862.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,1836.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1836.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1891.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1836.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3838.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1946.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1836.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1946.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3821,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1873.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3838.31,,facility
HLA I & II TYPING LR,81370,CPT,310,RC,,,,outpatient,,,2775,277.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,402.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,402.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,414.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,402.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,840.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,426.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,402.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,426.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,868.79,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,410.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,402.12,868.79,,facility
ASSAY OF URINE CREATININE,82570,CPT,301,RC,,,,outpatient,,,82,8.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.61,4.61,4.61,213,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,71.39,41.89,142.78,14,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,37.49,23.86,74.98,60,percent of total billed charges,,,33.6,,37.49,23.85,81.31,18,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,24.07,23.86,47.71,75,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,10.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,60.5,4.61,151,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,14.91,14.91,25.41,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,85.58,85.58,85.58,1 through 10,percent of total billed charges,,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.61,4.61,4.61,636,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.18,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.18,448,,facility
ORTHOTIC MGMT&TRAING 1ST ENC,97760,CPT,420,RC,,,,outpatient,,,315,31.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,80,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,44.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,42.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,89.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,45.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,42.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,45.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,422,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,43.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,42.91,448,,facility
DETECT AGENT NOS DNA AMP,87798,CPT,306,RC,,,,outpatient,,,180,18,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,110.88,110.88,174.24,1 through 10,percent of total billed charges,,,33.6,,244.27,244.27,244.27,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,96.77,32.38,119.79,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,38.9,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
BENZODIAZEPINES1-12,80346,CPT,301,RC,,,,outpatient,,,200,20,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
NFCT AGT GNTYP ALYS HIV1 REV,87901,CPT,306,RC,,,,outpatient,,,633,63.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,295,295,295,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,257.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,257.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,265.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,264,264,264,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,257.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,538.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,272.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,229,229,229,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,257.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,272.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,556.22,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,262.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,257.45,556.22,,facility
TEST FOR DETECTING GENES ASSOCIATED WITH FETAL DISEASE; MICRODELETION(S) GENOMIC SEQUENCE ANALYSIS,81422,CPT,0310,RC,,,,outpatient,,,1253,125.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,759.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,759.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,781.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,759.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1586.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,804.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,759.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,804.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1328.34,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,774.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1586.41,,facility
ASSAY OF VITAMIN B-6,84207,CPT,301,RC,,,,outpatient,,,330,33,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,24.99,24.99,24.99,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,48.53,48.53,48.53,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,43.43,43.43,43.43,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,27.55,18.82,27.55,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,28.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,58.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,29.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,24.99,24.99,24.99,18,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,28.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,29.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,60.71,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,28.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,28.1,448,,facility
X-RAY OF ELBOW; MINIMUM OF 3 VIEWS,73080,CPT,0320,RC,,,,outpatient,,,1023,102.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,85.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,174.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.68,19.68,39.36,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,84.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,83.29,448,,facility
MRI SCAN OF JAW JOINT,70336,CPT,0610,RC,,,,outpatient,,,7917,791.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,786,,,,,,,case rate,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,728,,,,,,,case rate,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1025,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1350,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,235.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,477.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,242.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,228.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,242.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2407,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,232.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,228.36,2407,,facility
VIRUS ANTIBODY NOS,86790,CPT,302,RC,,,,outpatient,,,237,23.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.46,11.46,11.46,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,107.86,20.06,169.49,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,116.52,40.29,122.3,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,26.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.46,11.46,11.46,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.88,448,,facility
CYTOGENETICS DNA PROBE,88271,CPT,311,RC,,,,outpatient,,,3063,306.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.05,19.05,19.05,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,1274.11,1274.11,1274.11,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,477.79,477.79,477.79,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,21.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,44.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.05,19.05,19.05,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,21.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,46.27,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,21.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,21.42,448,,facility
ASSAY DIPROPYLACETIC ACD TOT,80164,CPT,301,RC,,,,outpatient,,,593,59.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.04,12.04,12.04,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,47.04,47.04,47.04,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,28.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.04,12.04,12.04,12,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.26,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.54,448,,facility
ASSAY OF TRIGLYCERIDES,84478,CPT,301,RC,,,,outpatient,,,269,26.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.11,5.11,5.11,49,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,21.12,13.44,142.03,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,13.44,13.44,13.56,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.11,5.11,5.11,55,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.41,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.74,448,,facility
DETECTION TEST BY IMMUNOASSAY TECHNIQUE FOR CLOSTRIDIUM DIFFICILE TOXINS (STOOL PATHOGEN),87324,CPT,0306,RC,,,,outpatient,,,135,13.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.9,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.98,448,,facility
CLOSED TREATMENT OF DISLOCATED HAND JOINT AT BASE OF FINGER WITH MANIPULATION,26700,CPT,0450,RC,,,,outpatient,,,3201,320.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,243.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,493.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,240.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,236.08,493.41,,facility
CLOSED TREATMENT OF OTHER BROKEN WRIST BONE WITH MANIPULATION,25635,CPT,0450,RC,,,,outpatient,,,2910,291,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1585.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3216.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1631.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1631.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1569.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3216.38,,facility
MEASUREMENT OF COMPLEMENT (IMMUNE SYSTEM PROTEINS); TOTAL HEMOLYTIC,86162,CPT,0302,RC,,,,outpatient,,,109,10.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,36.62,36.62,36.62,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,20.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,42.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,21.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,18.07,18.07,18.07,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,20.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,21.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,43.91,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,20.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,20.32,448,,facility
IMMUNOASSAY NONANTIBODY,83516,CPT,301,RC,,,,outpatient,,,200,20,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9,9,10.26,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,4.75,4.75,218.59,30,percent of total billed charges,,,33.6,,3.02,3.02,175.39,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,3.02,3.02,211.68,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,24.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,23.5,23.5,23.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9,9,10.26,51,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.92,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,11.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.53,448,,facility
T CELLS COUNT; TOTAL,86359,CPT,0302,RC,,,,outpatient,,,167,16.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,33.56,33.56,33.56,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,37.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,37.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,82.68,82.68,82.68,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,78.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,39.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,33.56,33.56,33.56,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,39.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,81.52,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,38.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,37.73,448,,facility
SOCKET INSERT KNEE ARTICULAT,L5656,HCPCS,274,RC,,,,outpatient,,,692,69.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,66,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,61,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,465.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,465.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,479.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,465.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,972.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,493.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,465.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,493.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,474.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,465.36,972.6,,facility
CRYOPRECIPITATE; EACH UNIT,P9012,HCPCS,0390,RC,,,,outpatient,,,792,79.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,71.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,71.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,73.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,536.98,536.98,536.98,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,71.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,149.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,75.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,71.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,75.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,107,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,73.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,71.6,448,,facility
DTAP VACCINE < 7 YRS IM,90700,CPT,636,RC,,,,outpatient,,,86,8.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,78.53,78.53,78.53,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",448,448,,facility
ULTRASOUND SCAN OF PREGNANT UTERUS (LESS THAN 14 WEEKS); EACH ADDITIONAL FETUS,76802,CPT,0402,RC,,,,outpatient,,,1036,103.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,37.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,37.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,39.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,79.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,40.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,40.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,465,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,38.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,37.94,465,,facility
VITAMIN MEASUREMENT,84591,CPT,0301,RC,,,,outpatient,,,114,11.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,35.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.86,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.06,448,,facility
DETECTION TEST BY NUCLEIC ACID FOR TRICHOMONAS VAGINALIS (GENITAL PARASITE); AMPLIFIED PROBE TECHNIQUE,87661,CPT,0306,RC,,,,outpatient,,,216,21.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,57,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,127.44,127.44,127.44,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,114.05,72.58,123.34,1 through 10,percent of total billed charges,,,33.6,,28.9,28.9,114.05,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,72.58,28.9,73.22,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,91,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
SPLITTING OF BLOOD OR BLOOD PRODUCTS,86985,CPT,0390,RC,,,,outpatient,,,196,19.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,167.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,340.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,172.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,172.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,226.07,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,166.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,163.06,448,,facility
IMMUNODIFFUSION OUCHTERLONY,86331,CPT,302,RC,,,,outpatient,,,117,11.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.66,10.66,10.66,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.88,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.98,448,,facility
PHENOTYPE INFECT AGENT DRUG,87900,CPT,306,RC,,,,outpatient,,,598,59.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,130.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,130.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,134.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,130.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,272.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,138.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,130.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,138.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,281.61,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,132.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,130.35,448,,facility
MEASUREMENT OF ANTIBODY FOR RHEUMATOID ARTHRITIS ASSESSMENT,86200,CPT,0302,RC,,,,outpatient,,,120,12,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.52,11.52,11.52,14,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,70.8,70.8,70.8,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,63.36,25.87,63.36,1 through 10,percent of total billed charges,,,33.6,,40.32,40.32,63.36,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,33.26,16.46,40.68,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.52,11.52,11.52,56,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.97,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.95,448,,facility
MEASUREMENT OF ANTIBODY (IGE) TO ALLERGIC SUBSTANCE; CRUDE ALLERGEN EXTRACT; EACH,86003,CPT,0302,RC,,,,outpatient,,,11,1.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.64,4.64,4.64,14,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,77.88,77.88,77.88,12,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,110.88,18.14,178.46,68,percent of total billed charges,,,33.6,,110.88,110.88,110.88,30,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,110.88,44.35,161.62,185,percent of total billed charges,,,34.6,,125.73,125.73,125.73,30,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,10.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.64,4.64,4.64,26,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.27,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.22,448,,facility
REPOSITIONING OF PACEMAKER OR DEFIBRILLATOR ELECTRODE,33215,CPT,0361,RC,,,,outpatient,,,8412,841.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1027,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1519,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,3021.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3021.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3112.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3021.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,6315.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3203.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3021.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3203.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10137,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,3082.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,10137,,facility
X-RAY XM COLON 2CNTRST STD,74280,CPT,320,RC,,,,outpatient,,,2670,267,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,172.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,350.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,177.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,167.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,177.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,171.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,167.87,448,,facility
IDENTIFICATION OF RED BLOOD CELL ANTIBODIES,86870,CPT,0302,RC,,,,outpatient,,,126,12.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,315.62,315.62,343.05,52,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,343.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,343.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,353.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,289.34,289.34,578.69,17,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,198.92,198.92,596.77,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,343.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,716.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,363.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,23.42,23.42,46.84,19,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,343.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,363.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,377,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,349.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,343.05,716.97,,facility
CLOSED TREATMENT OF BROKEN COLLAR BONE,23500,CPT,0761,RC,,,,outpatient,,,798,79.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,210.47,210.47,210.47,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,243.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,493.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,213.62,213.62,213.62,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,240.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,236.08,1173,,facility
DEHYDROEPIANDROSTERONE (DHEA-S) HORMONE LEVEL,82627,CPT,0301,RC,,,,outpatient,,,75,7.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.77,19.77,19.77,24,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,44.25,44.25,44.25,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,39.6,39.6,142.03,1 through 10,percent of total billed charges,,,33.6,,25.2,25.2,25.2,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,25.2,25.2,90.38,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,46.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,23.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.77,19.77,19.77,42,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,23.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,48.04,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,22.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,22.23,448,,facility
9VHPV VACCINE 2/3 DOSE IM,90651,CPT,636,RC,,,,outpatient,,,824,82.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,307.43,307.43,307.43,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,464.23,464.23,464.23,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,287.31,287.31,287.31,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
ULTRASOUND EVALUATION OF BLOOD VESSEL WITH REVIEW BY RADIOLOGIST; EACH ADDITIONAL VESSEL,37253,CPT,0320,RC,,,,outpatient,,,8867,886.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,59.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,59.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,61.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,59.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,124.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,63.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,59.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,63.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,60.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,59.7,1173,,facility
RUBELLA ANTIBODY,86762,CPT,302,RC,,,,outpatient,,,257,25.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.8,12.8,12.8,18,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,28.32,28.32,28.32,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,25.34,16.13,25.34,14,percent of total billed charges,,,33.6,,16.13,16.13,16.13,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,16.13,16.13,16.27,22,percent of total billed charges,,,34.6,,68.61,68.61,68.61,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,30.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,24,24,44.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,12.8,12.8,12.8,1 through 10,percent of total billed charges,,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.8,12.8,12.8,185,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,31.1,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.39,448,,facility
ASY HYDROXYCORTICOSTEROIDS17,83491,CPT,301,RC,,,,outpatient,,,119,11.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,37.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,37.87,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.9,448,,facility
CLOSTRIDIUM AG IA,87324,CPT,306,RC,,,,outpatient,,,97,9.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.9,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.98,448,,facility
MOPATH PROCEDURE LEVEL 7,81406,CPT,310,RC,,,,outpatient,,,1670,167,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,282.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,282.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,291.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,282.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,591.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,299.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,282.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,299.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,495.04,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,288.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,282.88,591.22,,facility
EHRLICHIA ANTIBODY,86666,CPT,302,RC,,,,outpatient,,,249,24.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,7.53,7.53,7.53,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,21.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9.05,9.05,9.05,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.98,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,10.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,10.18,448,,facility
ASSAY OF MAGNESIUM,83735,CPT,301,RC,,,,outpatient,,,91,9.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.96,5.96,5.96,292,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,9.38,5.96,25.37,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,197.47,22.7,213.55,144,percent of total billed charges,,,33.6,,125.66,125.66,126.79,59,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,125.66,14.45,142.49,154,percent of total billed charges,,,34.6,,135.76,135.76,142.49,1 through 10,percent of total billed charges,,,45,,5.96,5.96,5.96,1 through 10,percent of total billed charges,,6.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,7.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,21.5,21.5,187,13,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,78.54,78.54,78.54,21,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.96,5.96,5.96,1555,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,7.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.47,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,6.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,6.7,448,,facility
DRUG SCREENING FENTANYL,80354,CPT,301,RC,,,,outpatient,,,43,4.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
MEASUREMENT OF LACOSAMIDE,80235,CPT,0300,RC,,,,outpatient,,,280,28,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,24.11,24.11,24.11,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,147.84,147.84,147.84,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,27.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,56.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,28.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,24.11,24.11,24.11,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,27.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,28.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,47.44,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,27.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,27.11,448,,facility
REVIEW BY RADIOLOGIST OF THE VEIN THAT TRANSPORTS BLOOD TO THE LIVER IMAGE WITH ASSESSMENT OF BLOOD FLOW,75885,CPT,0320,RC,,,,outpatient,,,8373,837.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3021.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3021.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3112.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3021.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,6315.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3203.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3021.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3203.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,3082.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,443,6315.75,,facility
URINALYSIS AUTO W/SCOPE,81001,CPT,307,RC,,,,outpatient,,,359,35.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,2.82,2.82,2.82,418,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,229.76,25.6,256,88,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,211.81,23.6,236,14,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,204.99,21.12,228.4,143,percent of total billed charges,,,33.6,,134.4,21.12,189.55,25,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,121.7,13.44,135.6,151,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,6.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,179.5,20,200,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,8.4,8.4,84,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,2.82,2.82,2.82,1909,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.86,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,3.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,3.17,448,,facility
DETECT AGENT NOS DNA AMP,87798,CPT,306,RC,,,,outpatient,,,299,29.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,110.88,110.88,174.24,1 through 10,percent of total billed charges,,,33.6,,244.27,244.27,244.27,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,96.77,32.38,119.79,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,38.9,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
URINALYSIS VOLUME MEASURE,81050,CPT,307,RC,,,,outpatient,,,83,8.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.24,3.24,3.24,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,3.7,3.36,3.7,1 through 10,percent of total billed charges,,,33.6,,3.36,3.36,3.36,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,3.36,3.36,3.36,1 through 10,percent of total billed charges,,,34.6,,3.99,3.99,3.99,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,7.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.24,3.24,98.45,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.49,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,3.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,3.64,448,,facility
VINBLASTINE SULFATE INJ,J9360,HCPCS,636,RC,,,,outpatient,,,15,1.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,151.73,151.73,151.73,11,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",448,448,,facility
HEARING LOSS DUP/DEL ANALYS,81431,CPT,310,RC,,,,outpatient,,,1500,150,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,679.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,679.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,699.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,679.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1420.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,720.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,679.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,720.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1189.25,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,693.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1420.3,,facility
MEASUREMENT OF HEPATITIS A ANTIBODY (IGM),86709,CPT,0302,RC,,,,outpatient,,,119,11.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.02,10.02,10.02,22,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,76.16,76.16,76.16,19,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,70.21,70.21,70.21,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,62.83,62.83,62.83,1 through 10,percent of total billed charges,,,33.6,,39.98,39.98,62.83,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,39.98,39.98,40.34,13,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,23.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,59.5,59.5,59.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.02,10.02,10.02,66,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.33,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,11.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.26,448,,facility
FLOWCYTOMETRY/ TC 1 MARKER,88184,CPT,311,RC,,,,outpatient,,,2933,293.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,315.62,315.62,343.05,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,546.56,546.56,731.52,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,343.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,343.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,353.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,286.94,286.94,384.05,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,343.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,716.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,363.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,179.34,179.34,179.34,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,63.07,63.07,165.15,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,343.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,363.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,377,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,349.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,343.05,716.97,,facility
QUANTITATIVE ASSAY DRUG,80299,CPT,301,RC,,,,outpatient,,,128,12.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,13,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,174.64,174.64,174.64,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,171.6,171.6,171.6,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,374.52,374.52,374.52,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.62,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.64,448,,facility
TEST FOR DETECTING GENES ASSOCIATED WITH BLOOD RELATED CANCER,81450,CPT,0300,RC,,,,outpatient,,,5884,588.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,675.59,675.59,675.59,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,759.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,759.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,782.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,759.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1587.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,805.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,675.59,675.59,675.59,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,759.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,805.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1329.18,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,774.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1587.42,,facility
COMPLEMENT ANTIGEN,86160,CPT,302,RC,,,,outpatient,,,344,34.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.67,10.67,10.67,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,87.32,87.32,87.32,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,78.14,49.73,270.86,17,percent of total billed charges,,,33.6,,49.73,49.73,172.37,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,49.73,29.23,50.32,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,256.5,256.5,256.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.67,10.67,10.67,61,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.92,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12,448,,facility
GENOME SEQUENCE ANALYSIS,81426,CPT,310,RC,,,,outpatient,,,3388,338.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2709.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2709.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2791.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2709.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,5663.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2872.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2709.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2872.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4742.41,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,2764.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,5663.8,,facility
ADMINISTRATION OF DEVELOPMENTAL TEST; FIRST HOUR,96112,CPT,0918,RC,,,,outpatient,,,534,53.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,123.14,113.58,137.28,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,123.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,123.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,126.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,50,50,50,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,123.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,257.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,130.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,55.8,55.8,55.8,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,123.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,130.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1372,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,125.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,123.14,1372,,professional
RBC PRETX INCUBATJ W/CHEMICL,86970,CPT,302,RC,,,,outpatient,,,150,15,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,56.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,56.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,58.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,145.56,145.56,145.56,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,56.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,118,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,59.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,56.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,59.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,55.65,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,57.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,55.65,448,,facility
DIAGNOSTIC EXAM OF ESOPHAGUS; STOMACH; AND/OR UPPER SMALL BOWEL USING A FLEXIBLE ENDOSCOPE,43235,CPT,0750,RC,,,,outpatient,,,4012,401.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,770.12,408.37,822.62,24,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,868.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,868.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,894.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,868.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1814.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,920.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,834.91,417.46,834.91,22,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,868.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,920.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3821,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,885.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3821,,facility
REVIEW BY RADIOLOGIST OF IMAGE FOR INSERTION OF MATERIAL TO BLOCK BLOOD FLOW,75894,CPT,0320,RC,,,,outpatient,,,9049,904.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,119.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,119.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,123.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,119.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,250.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,127.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,119.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,127.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,122.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,119.91,448,,facility
NEG PRS WND THR NDME<=50SQCM,97607,CPT,450,RC,,,,outpatient,,,1370,137,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,400.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,813.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,412.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,412.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,396.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,389.05,813.11,,facility
SIMPLE REPAIR OF SURFACE WOUND OF FACE; EARS; EYELIDS; NOSE; LIPS; OR MOUTH; 7.6-12.5 CM,12015,CPT,0450,RC,,,,outpatient,,,1584,158.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,197.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,401.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,203.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,176.95,176.95,176.95,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,203.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,195.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,192.01,1173,,facility
X-RAY OF RIBS ON BOTH SIDES OF BODY; MINIMUM OF 4 VIEWS,71111,CPT,0320,RC,,,,outpatient,,,1778,177.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,103.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,209.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,100.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,106.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,102.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,100.06,448,,facility
LIPID PANEL,80061,CPT,301,RC,,,,outpatient,,,8.6,0.86,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.91,11.91,11.91,1021,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,34.81,34.81,34.81,26,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,37.76,37.76,37.76,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,31.15,19.82,31.15,172,percent of total billed charges,,,33.6,,20,19.82,31.15,37,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,19.82,19.82,20,389,percent of total billed charges,,,34.6,,21.83,21.83,21.83,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,29.5,29.5,123.5,11,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,12.39,12.39,51.87,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.91,11.91,11.91,1133,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.93,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.39,448,,facility
HC ANES GENERAL 1ST HR,3.7E+12,CDM,370,RC,,,,outpatient,,,150,15,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 103.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 209.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 100.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 106.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS.",,,,0,other,"Payer contract is 102.00% of Medicare but standard charge is packaged, not separately payable under Medicare OPPS. + No services performed during 15-month lookback period",448,448,,facility
ASSAY OF INSULIN,83525,CPT,301,RC,,,,outpatient,,,9,0.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.17,10.17,10.17,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,20.83,20.83,20.83,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,21.02,20.83,63.84,11,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,23.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.17,10.17,10.17,12,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.69,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,11.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.43,448,,facility
HEPATIC FUNCTION PANEL,80076,CPT,301,RC,,,,outpatient,,,8,0.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,17.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.66,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,8.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,8.17,448,,facility
PREV VISIT NEW AGE 40-64,99386,CPT,510,RC,,,,outpatient,,,523,52.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,98.82,98.82,98.82,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
ASSAY OF TRIGLYCERIDES,84478,CPT,301,RC,,,,outpatient,,,10,1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.11,5.11,5.11,49,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,21.12,13.44,142.03,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,13.44,13.44,13.56,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.11,5.11,5.11,55,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.41,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.74,448,,facility
IMMUNOASSAY QUANT NOS NONAB,83520,CPT,301,RC,,,,outpatient,,,50,5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,36,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,66.08,66.08,66.08,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,41.18,24.82,318.38,1 through 10,percent of total billed charges,,,33.6,,37.63,37.63,96.43,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,33.6,23.18,176.4,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,36.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,87,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.22,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.27,448,,facility
ASSAY OF ETHOSUXIMIDE,80168,CPT,301,RC,,,,outpatient,,,38.65,3.87,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,34.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,14.53,14.53,14.53,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.3,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,16.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,16.34,448,,facility
UNLISTED CHEMISTRY PROCEDURE,84999,CPT,301,RC,,,,outpatient,,,448,44.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
DRUG SCRN QUANT OXCARBAZEPIN,80183,CPT,301,RC,,,,outpatient,,,31.5,3.15,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.79,11.79,11.79,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.79,11.79,11.79,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.63,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.25,448,,facility
SPECTROPHOTOMETRY,84311,CPT,301,RC,,,,outpatient,,,382,38.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,7.2,7.2,7.2,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,45.35,45.35,53.33,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,16.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,7.2,7.2,7.2,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.1,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,8.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,8.1,448,,facility
F5 GENE,81241,CPT,310,RC,,,,outpatient,,,205,20.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,65.26,65.26,65.26,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,73.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,73.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,219.41,219.41,219.41,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,73.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,153.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,77.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,65.26,65.26,65.26,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,73.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,77.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,132.02,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,74.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,73.37,448,,facility
OCCULT BLD FECES 1-3 TESTS,82272,CPT,301,RC,,,,outpatient,,,6.86,0.69,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.76,3.76,3.76,11,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,8.96,8.96,8.96,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,4.7,4.7,7.39,1 through 10,percent of total billed charges,,,33.6,,7.39,7.39,7.39,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,8.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,24,24,24,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.76,3.76,3.76,31,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.4,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,4.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,4.23,448,,facility
HUMAN EPIDIDYMIS PROTEIN 4,86305,CPT,302,RC,,,,outpatient,,,275,27.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,20.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,43.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,20.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,44.98,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,21.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,20.81,448,,facility
NFCT AGT GNTYP ALYS HIV1 REV,87901,CPT,306,RC,,,,outpatient,,,690,69,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,295,295,295,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,257.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,257.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,265.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,264,264,264,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,257.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,538.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,272.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,229,229,229,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,257.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,272.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,556.22,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,262.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,257.45,556.22,,facility
DETECT AGENT NOS DNA AMP,87798,CPT,306,RC,,,,outpatient,,,265,26.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,110.88,110.88,174.24,1 through 10,percent of total billed charges,,,33.6,,244.27,244.27,244.27,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,96.77,32.38,119.79,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,38.9,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
ASSAY ALKALINE PHOSPHATASES,84080,CPT,301,RC,,,,outpatient,,,49.45,4.95,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.15,13.15,13.15,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,12.43,12.43,12.43,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,12.43,12.43,12.54,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,30.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.15,13.15,13.15,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,31.94,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,15.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.78,448,,facility
NUCLEAR ANTIGEN ANTIBODY,86235,CPT,302,RC,,,,outpatient,,,194,19.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13,12.5,15.95,11,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,54.91,4.37,90.29,43,percent of total billed charges,,,33.6,,4.37,4.37,53.09,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,22.18,4.24,83.33,13,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,37.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.95,13,15.95,54,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.75,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.93,448,,facility
ASSAY OF NOS VITAMIN,84591,CPT,301,RC,,,,outpatient,,,250,25,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,35.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.86,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.06,448,,facility
ANTIPSYCHOTICS NOS 1-3,80342,CPT,301,RC,,,,outpatient,,,49.25,4.93,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
SERPINA1 GENE,81332,CPT,310,RC,,,,outpatient,,,237.9,23.79,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,38.83,38.83,38.83,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,43.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,43.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,44.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,43.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,91.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,46.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,43.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,46.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,94.31,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,44.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,43.65,448,,facility
FREE ASSAY (FT-3),84481,CPT,301,RC,,,,outpatient,,,27,2.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.07,15.07,15.07,40,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,93.81,93.81,276.71,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,83.95,53.42,157.58,12,percent of total billed charges,,,33.6,,53.42,53.42,157.58,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,53.42,53.42,157.58,33,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,35.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.07,15.07,15.07,127,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.61,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,16.94,448,,facility
DETECT AGENT NOS DNA AMP,87798,CPT,306,RC,,,,outpatient,,,212,21.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,110.88,110.88,174.24,1 through 10,percent of total billed charges,,,33.6,,244.27,244.27,244.27,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,96.77,32.38,119.79,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,38.9,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
ASSAY OF SERUM POTASSIUM,84132,CPT,301,RC,,,,outpatient,,,22,2.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.23,4.23,4.23,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,9.52,9.52,9.52,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,39.4,23.18,39.4,1 through 10,percent of total billed charges,,,33.6,,23.18,23.18,23.18,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,23.18,19.49,46.37,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,9.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.23,4.23,4.23,39,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.94,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,4.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,4.76,448,,facility
ALLG SPEC IGE RECOMB EA,86008,CPT,302,RC,,,,outpatient,,,53,5.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,37.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.75,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.93,448,,facility
BENZODIAZEPINES 13 OR MORE,80347,CPT,301,RC,,,,outpatient,,,35,3.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
MOPATH PROCEDURE LEVEL 6,81405,CPT,310,RC,,,,outpatient,,,365,36.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,301.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,301.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,310.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,301.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,629.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,319.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,301.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,319.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,527.36,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,307.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,301.35,629.82,,facility
IMMUNOFIX E-PHORESIS SERUM,86334,CPT,302,RC,,,,outpatient,,,30,3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.87,19.87,19.87,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,23.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,14.26,14.26,56.5,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,27.8,8.98,35.95,1 through 10,percent of total billed charges,,,34.6,,38.84,31.24,40.77,11,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,46.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,23.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,19.87,19.87,19.87,37,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,23.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,48.28,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,22.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,22.34,448,,facility
URINALYSIS AUTO W/O SCOPE,81003,CPT,307,RC,,,,outpatient,,,5,0.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,2,2,2,141,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,148.09,148.09,148.09,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,143.32,15.84,143.32,137,percent of total billed charges,,,33.6,,84.34,9.5,143.32,35,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,84.34,10.08,85.09,61,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,4.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,125.5,125.5,125.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,251,251,251,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,2,2,2,1 through 10,percent of total billed charges,,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,2,2,2,997,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.85,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,2.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,2.25,448,,facility
UNLISTED MOLECULAR PATHOLOGY,81479,CPT,310,RC,,,,outpatient,,,798,79.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,561.56,561.56,561.56,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,32.5,32.5,3071.5,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
FLT3 GENE ANALYSIS,81246,CPT,310,RC,,,,outpatient,,,335,33.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,85.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,173.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,87.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,87.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,145.25,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,84.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,83,448,,facility
MOPATH PROCEDURE LEVEL 7,81406,CPT,310,RC,,,,outpatient,,,178,17.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,282.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,282.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,291.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,282.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,591.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,299.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,282.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,299.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,495.04,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,288.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,282.88,591.22,,facility
NOS EACH ORGANISM AG IA,87449,CPT,306,RC,,,,outpatient,,,48.75,4.88,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,198,198,198,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,26.27,26.27,26.27,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.66,10.66,10.66,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.9,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.98,448,,facility
QUANTITATIVE ASSAY DRUG,80299,CPT,301,RC,,,,outpatient,,,129,12.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,13,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,174.64,174.64,174.64,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,171.6,171.6,171.6,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,374.52,374.52,374.52,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.62,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.64,448,,facility
ENCEPHALITIS CALIFORN ANTBDY,86651,CPT,302,RC,,,,outpatient,,,43,4.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.49,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.19,448,,facility
ANTINUCLEAR ANTIBODIES,86038,CPT,302,RC,,,,outpatient,,,16,1.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.75,10.75,10.75,34,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,148.09,148.09,148.09,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,84.34,29.04,132.53,14,percent of total billed charges,,,33.6,,84.34,18.48,127.78,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,84.34,84.34,85.09,12,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,11.55,11.55,11.55,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.75,10.75,10.75,126,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.11,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.09,448,,facility
CMV ANTIBODY,86644,CPT,302,RC,,,,outpatient,,,31.25,3.13,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.8,12.8,12.8,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,30.08,30.08,85.12,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,70.22,44.69,76.56,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,49.24,48.72,49.24,1 through 10,percent of total billed charges,,,34.6,,48.28,17.91,50.67,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,30.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.8,12.8,12.8,11,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,31.1,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.39,448,,facility
DETECT AGENT NOS DNA AMP,87798,CPT,306,RC,,,,outpatient,,,260,26,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,31.21,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,110.88,110.88,174.24,1 through 10,percent of total billed charges,,,33.6,,244.27,244.27,244.27,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,96.77,32.38,119.79,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,73.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,31.21,31.21,38.9,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,35.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.09,448,,facility
DRUG TEST PRSMV CHEM ANLYZR,80307,CPT,301,RC,,,,outpatient,,,415,41.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,55.27,55.27,55.27,34,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,62.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,62.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,171.87,131.38,223.26,14,percent of total billed charges,,,33.6,,206.45,131.38,223.26,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,131.38,102.04,131.38,13,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,62.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,129.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,65.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,55.27,55.27,55.27,332,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,62.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,65.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,125.7,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,63.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,62.14,448,,facility
FUNGUS NES ANTIBODY,86671,CPT,302,RC,,,,outpatient,,,22,2.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.48,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.25,448,,facility
ASSAY OF PROSTAGLANDIN,84150,CPT,301,RC,,,,outpatient,,,289.4,28.94,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,41.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,41.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,43.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,41.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,87.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,44.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,41.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,44.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,73.1,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,42.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,41.77,448,,facility
IBMFS SEQ ALYS PNL 30 GENES,81441,CPT,310,RC,,,,outpatient,,,6775,677.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2448.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2448.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2522.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2448.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,5117.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2595.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2448.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2595.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4284.98,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,2497.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,5117.49,,facility
"ASY CARBAMAZEPIN 10,11-EPXID",80161,CPT,301,RC,,,,outpatient,,,33.15,3.32,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.62,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.64,448,,facility
IMMUNOASSAY NONANTIBODY,83516,CPT,301,RC,,,,outpatient,,,41.5,4.15,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9,9,10.26,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,4.75,4.75,218.59,30,percent of total billed charges,,,33.6,,3.02,3.02,175.39,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,3.02,3.02,211.68,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,24.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,23.5,23.5,23.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9,9,10.26,51,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.92,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,11.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.53,448,,facility
SRS LINEAR BASED,77372,CPT,333,RC,,,,outpatient,,,9274.55,927.46,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,6707.31,6707.31,6707.31,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7049.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7049.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7260.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,7049.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,14732.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,7471.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,6807.53,6807.53,6807.53,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,7049.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,7471.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,48815,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,7189.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,48815,,facility
BRAF GENE,81210,CPT,310,RC,,,,outpatient,,,370,37,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,156.02,156.02,156.02,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,175.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,175.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,180.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,175.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,366.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,185.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,156.02,156.02,156.02,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,175.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,185.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,306.95,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,178.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,175.4,448,,facility
VITAL CAPACITY TEST,94150,CPT,460,RC,,,,outpatient,,,186.04,18.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,123.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,123.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,126.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,123.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,257.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,130.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,123.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,130.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,611,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,125.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,123.14,611,,facility
TREAT STERNUM FRACTURE,21820,CPT,450,RC,,,,outpatient,,,280.86,28.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,243.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,493.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,240.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,236.08,1173,,facility
OPIATES 1 OR MORE,80361,CPT,301,RC,,,,outpatient,,,119,11.9,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
ASSAY OF G6PD ENZYME,82955,CPT,301,RC,,,,outpatient,,,150,15,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,9.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,20.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,9.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.95,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,9.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,9.7,448,,facility
EPSTEIN-BARR NUCLEAR ANTIGEN,86664,CPT,302,RC,,,,outpatient,,,17.1,1.71,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.6,13.6,13.6,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,49.92,22.4,49.92,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,41.18,41.18,41.18,1 through 10,percent of total billed charges,,,33.6,,71.57,71.57,71.57,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,28.56,28.56,71.57,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,31.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.6,13.6,13.6,15,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,33.04,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,15.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,15.29,448,,facility
IMMUNOASSAY QUANT NOS NONAB,83520,CPT,301,RC,,,,outpatient,,,71,7.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,36,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,66.08,66.08,66.08,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,41.18,24.82,318.38,1 through 10,percent of total billed charges,,,33.6,,37.63,37.63,96.43,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,33.6,23.18,176.4,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,36.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,87,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.22,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.27,448,,facility
ASSAY OF SOMATOSTATIN,84307,CPT,301,RC,,,,outpatient,,,254,25.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,39.48,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.28,448,,facility
RADEX ABDOMEN 1 VIEW,74018,CPT,320,RC,,,,outpatient,,,108.23,10.82,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,83.75,83.75,83.75,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,458.24,458.24,458.24,17,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,422.44,422.44,422.44,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,85.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,242.72,240.58,378.05,12,percent of total billed charges,,,33.6,,240.58,240.58,240.58,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,240.58,240.58,242.72,11,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,174.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,358,358,358,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,17.25,17.25,18.03,88,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,83.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,88.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,84.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,83.29,448,,facility
ASSAY OF GALACTOSE,82760,CPT,301,RC,,,,outpatient,,,13.1,1.31,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9.96,9.96,9.96,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,23.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9.96,9.96,9.96,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.19,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,11.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.2,448,,facility
MUMPS ANTIBODY,86735,CPT,302,RC,,,,outpatient,,,34.8,3.48,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.61,11.61,11.61,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,22.18,22.18,85.01,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,68.61,68.61,68.61,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,44,44,44,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.61,11.61,11.61,15,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.19,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.05,448,,facility
CRYPTOCOCCUS ANTIBODY,86641,CPT,302,RC,,,,outpatient,,,53.1,5.31,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,30.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,31.13,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.41,448,,facility
ASSAY BLD/SERUM CHOLESTEROL,82465,CPT,301,RC,,,,outpatient,,,30,3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.87,3.87,3.87,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,20.83,20.83,20.83,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,9.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,3.87,3.87,3.87,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.4,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,4.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,4.35,448,,facility
SC STD AGAR DILUTION PER AGT,87181,CPT,306,RC,,,,outpatient,,,190,19,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,9.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.26,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,4.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,4.75,448,,facility
MONONUCLEAR CELL ANTIGEN,86356,CPT,302,RC,,,,outpatient,,,56.75,5.68,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,23.82,23.82,23.82,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,138.06,138.06,552.24,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,464.64,464.64,464.64,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,26.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,55.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,28.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,23.82,23.82,23.82,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,26.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,28.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,57.86,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,27.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,26.78,448,,facility
HEMATOCRIT,85014,CPT,305,RC,,,,outpatient,,,2.19,0.22,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,2.11,2.11,2.11,26,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,12.16,12.16,78.72,14,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,3.32,3.32,11.21,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,68.24,41.33,70.23,31,percent of total billed charges,,,33.6,,10.03,10.03,41.33,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,41.33,6.38,41.7,26,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,4.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,61.5,9.5,61.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,2.11,2.11,2.11,164,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.13,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,2.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,2.37,448,,facility
OTHER SOURCE ALBUMIN QUAN EA,82042,CPT,301,RC,,,,outpatient,,,21.85,2.19,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,107.76,107.76,107.76,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,7.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,16.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,6.92,6.92,6.92,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,7.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.62,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,7.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,7.78,448,,facility
ASSAY OF NICKEL,83885,CPT,301,RC,,,,outpatient,,,101.85,10.19,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,24.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,51.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,25.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,24.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,25.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,52.96,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,24.51,448,,facility
MTHFR GENE,81291,CPT,310,RC,,,,outpatient,,,255,25.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,65.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,65.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,67.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,65.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,136.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,69.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,65.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,69.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,114.35,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,66.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,65.34,448,,facility
ASSAY OF THYROGLOBULIN,84432,CPT,301,RC,,,,outpatient,,,4.5,0.45,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,14.29,14.29,14.29,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,5.9,5.9,33.04,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,5.28,3.36,29.57,1 through 10,percent of total billed charges,,,33.6,,14.58,14.58,18.82,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,14.58,3.36,18.82,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,33.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,14.29,10,14.29,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,34.7,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,16.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,16.06,448,,facility
ANCA TITER EACH ANTIBODY,86037,CPT,302,RC,,,,outpatient,,,17,1.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,85.68,85.68,85.68,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,75.26,75.26,75.26,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.09,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.05,448,,facility
IGH GENE REARRANGE AMP METH,81261,CPT,310,RC,,,,outpatient,,,310,31,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,197.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,197.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,203.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,399.5,399.5,399.5,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,197.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,413.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,209.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,197.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,209.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,427.75,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,201.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,197.99,448,,facility
MICROSATELLITE INSTABILITY,81301,CPT,310,RC,,,,outpatient,,,750,75,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,310.04,310.04,310.04,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,348.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,348.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,359.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,403.87,403.87,403.87,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,348.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,728.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,369.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,348.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,369.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,625.59,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,355.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,348.56,728.49,,facility
ASSAY OF VOLATILES,84600,CPT,301,RC,,,,outpatient,,,78,7.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,35.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,34.74,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.11,448,,facility
IMMUNOASSAY INFECTIOUS AGENT,86317,CPT,302,RC,,,,outpatient,,,12.6,1.26,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.33,13.33,13.33,86,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,59,59,59,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,52.8,26.54,52.8,41,percent of total billed charges,,,33.6,,52.8,33.6,52.8,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,33.6,33.6,33.73,52,percent of total billed charges,,,34.6,,218.53,218.53,218.53,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,31.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,50,50,50,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,13.33,13.33,13.33,209,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.38,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,15.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.99,448,,facility
ACUTE HEPATITIS PANEL,80074,CPT,302,RC,,,,outpatient,,,65,6.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,42.37,42.37,42.37,53,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,102.07,102.07,319.78,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,47.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,47.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,49.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,91.34,58.13,309.48,14,percent of total billed charges,,,33.6,,91.48,91.48,91.48,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,58.13,58.13,58.73,15,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,47.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,99.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,50.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,42.37,42.37,42.37,95,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,47.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,50.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,102.92,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,48.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,47.63,448,,facility
ASSAY OF GLUTATHIONE,82978,CPT,301,RC,,,,outpatient,,,116,11.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,32.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.8,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,15.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,15.45,448,,facility
NOONAN SPECTRUM DISORDERS,81442,CPT,310,RC,,,,outpatient,,,2200,220,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2143.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2143.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2207.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2143.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,4480.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2272.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2143.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2272.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3751.3,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,2186.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,4480.12,,facility
ASSAY THREE CATECHOLAMINES,82384,CPT,301,RC,,,,outpatient,,,57.5,5.75,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,22.46,22.46,22.46,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,25.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,52.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,26.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,22.46,22.46,22.46,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,25.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,26.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,54.57,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,25.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,25.25,448,,facility
VIRUS INOCULATION TISSUE,87252,CPT,306,RC,,,,outpatient,,,182.5,18.25,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,26.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,54.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,27.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,26.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,27.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,56.32,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,26.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,26.07,448,,facility
AGENT NOS ASSAY W/OPTIC,87899,CPT,306,RC,,,,outpatient,,,55,5.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,33.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,14.29,14.29,14.29,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.12,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,16.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,16.07,448,,facility
ASSAY OF IGE,82785,CPT,301,RC,,,,outpatient,,,51,5.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,14.64,14.64,14.64,32,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,44.88,28.56,175.87,1 through 10,percent of total billed charges,,,33.6,,124.52,124.52,124.52,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,28.56,28.56,28.56,1 through 10,percent of total billed charges,,,34.6,,32.29,32.29,117.35,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,34.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,14.64,14.64,14.64,106,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.56,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,16.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,16.46,448,,facility
HEMOGLOBIN-OXYGEN AFFINITY,82820,CPT,301,RC,,,,outpatient,,,16.68,1.67,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,23.35,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.34,448,,facility
ASSAY OF CALCIUM,82330,CPT,301,RC,,,,outpatient,,,35,3.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.17,12.17,12.17,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,85.31,18.14,138.18,19,percent of total billed charges,,,33.6,,81.31,81.31,81.31,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,64.41,18.14,81.31,24,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,28.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,50.82,50.82,50.82,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.17,12.17,12.17,185,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.54,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.68,448,,facility
ALPHA-1-ANTITRYPSIN TOTAL,82103,CPT,301,RC,,,,outpatient,,,107.5,10.75,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.95,11.95,11.95,14,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,15.79,11.42,30.1,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,19.15,11.42,48.05,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,28.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.95,11.95,11.95,58,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.03,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.44,448,,facility
CARCINOEMBRYONIC ANTIGEN,82378,CPT,301,RC,,,,outpatient,,,36,3.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.86,16.86,16.86,25,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,89.04,28.9,139.92,41,percent of total billed charges,,,33.6,,89.04,28.9,89.04,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,28.9,28.9,89.04,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,39.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,20.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,132.5,132.5,132.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.86,16.86,16.86,36,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,20.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,40.97,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.96,448,,facility
DRUG ASSAY CYCLOSPORINE,80158,CPT,301,RC,,,,outpatient,,,20.2,2.02,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,254.93,70.9,254.93,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,37.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.06,16.06,16.06,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.99,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.05,448,,facility
RIA NONANTIBODY,83519,CPT,301,RC,,,,outpatient,,,340,34,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,55.44,55.44,55.44,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.37,16.37,16.37,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.2,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,18.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.4,448,,facility
DRUG TEST PRSMV CHEM ANLYZR,80307,CPT,301,RC,,,,outpatient,,,585,58.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,55.27,55.27,55.27,34,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,62.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,62.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,171.87,131.38,223.26,14,percent of total billed charges,,,33.6,,206.45,131.38,223.26,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,131.38,102.04,131.38,13,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,62.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,129.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,65.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,55.27,55.27,55.27,332,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,62.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,65.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,125.7,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,63.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,62.14,448,,facility
CHEMILUMINESCENT ASSAY,82397,CPT,301,RC,,,,outpatient,,,220,22,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.56,12.56,12.56,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,22.85,22.85,22.85,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,29.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.56,12.56,12.56,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.5,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.12,448,,facility
ELECTROPHORETIC TEST,82664,CPT,301,RC,,,,outpatient,,,126,12.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,61.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,61.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,63.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,61.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,128.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,65.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,61.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,65.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,107.63,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,62.73,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,61.5,448,,facility
EL-1 FECAL QUANTITATIVE,82653,CPT,301,RC,,,,outpatient,,,147,14.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,20.43,20.43,20.43,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,23.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,262.42,103.49,262.42,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,65.86,65.86,65.86,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,48.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,24.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,20.43,20.43,20.43,28,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,24.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,40.2,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,23.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,22.97,448,,facility
ASSAY OF PARATHORMONE,83970,CPT,301,RC,,,,outpatient,,,30,3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,36.72,36.72,36.72,87,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,67.85,67.85,67.85,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,41.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,41.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,60.72,38.64,209.62,23,percent of total billed charges,,,33.6,,38.64,38.64,38.64,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,38.99,38.64,134.58,39,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,41.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,86.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,43.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,83.37,83.37,83.37,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,36.72,36.72,36.72,244,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,41.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,43.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,89.18,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,42.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,41.28,448,,facility
SUGARS MULTIPLE QUAL,84377,CPT,301,RC,,,,outpatient,,,153,15.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,11.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.88,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.5,448,,facility
ASSAY OF URINE SULFATE,84392,CPT,301,RC,,,,outpatient,,,63.5,6.35,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,11.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.26,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.49,448,,facility
COMPLETE CBC AUTOMATED,85027,CPT,305,RC,,,,outpatient,,,6,0.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.75,5.75,5.75,606,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,35.2,35.04,164.48,198,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,32.45,32.45,151.63,29,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,35.04,35.04,35.2,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,86.35,18.48,146.75,217,percent of total billed charges,,,33.6,,86.35,18.56,87.12,62,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,18.56,18.48,87.12,248,percent of total billed charges,,,34.6,,93.29,93.29,93.29,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,13.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,27.5,27.38,128.5,30,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,53.97,53.97,53.97,11,percent of total billed charges,,,35,,128.5,128.5,128.5,1 through 10,percent of total billed charges,,,40,,5.75,5.75,5.75,1 through 10,percent of total billed charges,,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.75,5.75,5.75,2267,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.97,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,6.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,6.47,448,,facility
IMMUNOASSAY QUANT NOS NONAB,83520,CPT,301,RC,,,,outpatient,,,109.05,10.91,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,36,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,66.08,66.08,66.08,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.79,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,41.18,24.82,318.38,1 through 10,percent of total billed charges,,,33.6,,37.63,37.63,96.43,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,33.6,23.18,176.4,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,36.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.36,15.36,15.36,87,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.22,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,17.27,448,,facility
ASSAY OF COPPER,82525,CPT,301,RC,,,,outpatient,,,42.5,4.25,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.04,11.04,11.04,18,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,35.64,22.85,35.9,1 through 10,percent of total billed charges,,,33.6,,80.64,80.64,80.64,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,22.85,19.49,22.85,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,50.4,50.4,50.4,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.04,11.04,11.04,37,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.81,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.41,448,,facility
ASSAY OF C-PEPTIDE,84681,CPT,301,RC,,,,outpatient,,,45.06,4.51,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,18.51,18.51,18.51,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,283.54,283.54,283.54,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,54.1,54.1,54.58,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,20.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,43.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,18.51,18.51,18.51,11,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,20.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,44.98,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,21.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,20.81,448,,facility
DRUG TEST DEF 1-7 CLASSES,G0480,HCPCS,301,RC,,,,outpatient,,,15,1.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,101.78,101.78,101.78,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,36.32,36.32,36.32,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,114.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,114.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,117.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,104.49,61.49,104.49,27,percent of total billed charges,,,33.6,,61.49,61.49,104.51,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,61.49,47.8,61.49,11,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,114.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,239.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,121.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,91.5,91.5,91.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,101.78,101.78,101.78,280,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,114.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,121.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,200.25,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,116.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,114.43,448,,facility
ALKALOIDS NOS,80323,CPT,301,RC,,,,outpatient,,,143,14.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
ENTAMOEB HIST GROUP AG IA,87337,CPT,306,RC,,,,outpatient,,,103,10.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.9,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,11.98,448,,facility
ASSAY OF URINE CHLORIDE,82436,CPT,301,RC,,,,outpatient,,,7,0.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.11,5.11,5.11,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,91.39,91.39,92.21,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,12.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,24.5,24.5,136,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.11,5.11,5.11,20,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.87,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.75,448,,facility
ASSAY OF TOTAL TESTOSTERONE,84403,CPT,301,RC,,,,outpatient,,,57,5.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,22.96,20,22.96,75,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,44.84,11.8,294.41,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.58,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,35.9,10.56,263.47,33,percent of total billed charges,,,33.6,,40.13,25.54,169.16,16,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,25.54,6.72,167.66,56,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,25.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,53.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,27.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,38,38,38,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,4.2,4.2,4.2,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,22.96,20,22.96,116,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,25.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,27.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,55.77,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,26.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,25.81,448,,facility
ASSAY OF AMYLASE,82150,CPT,301,RC,,,,outpatient,,,14,1.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.76,5.76,5.76,19,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,95,95,95,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,54.24,31.92,54.25,46,percent of total billed charges,,,33.6,,31.92,27.12,54.24,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,31.92,27.12,31.92,11,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,13.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,40,40,47.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,5.76,5.76,5.76,306,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,6.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,6.48,448,,facility
AMINO ACIDS QUAN 6 OR MORE,82139,CPT,301,RC,,,,outpatient,,,295,29.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.01,12,15.01,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,230.18,110.21,262.42,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,35.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,164.01,164.01,164.01,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,15.01,12,15.01,16,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.45,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,16.87,448,,facility
BENZODIAZEPINES1-12,80346,CPT,301,RC,,,,outpatient,,,204,20.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 103.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 209.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 100.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 106.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment.,,,,0,other,Payer contract is 102.00% of Medicare but standard charge is not recognized under Medicare APC payment. + No services performed during 15-month lookback period,448,448,,facility
CULTURE AEROBIC IDENTIFY,87077,CPT,306,RC,,,,outpatient,,,12,1.2,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,7.19,7.19,7.19,67,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,101.48,25.96,101.48,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,90.82,57.79,154.46,34,percent of total billed charges,,,33.6,,57.79,53.5,90.82,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,57.79,14.92,58.31,28,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,16.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,86,86,172,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,36.12,36.12,36.12,1 through 10,percent of total billed charges,,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,7.19,7.19,7.19,240,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.45,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,8.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,8.08,448,,facility
MACROSCOPIC EXAM PARASITE,87169,CPT,306,RC,,,,outpatient,,,7,0.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,4.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,9.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,4.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,4.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.22,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,4.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,4.31,448,,facility
HEP B CORE ANTIBODY TOTAL,86704,CPT,302,RC,,,,outpatient,,,28,2.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.72,10.72,10.72,67,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,71.68,71.68,83.84,35,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,66.08,66.08,66.08,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,59.14,37.63,59.14,29,percent of total billed charges,,,33.6,,59.14,37.63,59.14,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,37.63,37.63,37.97,41,percent of total billed charges,,,34.6,,38.48,13.53,47.55,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,56,56,56,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,10.72,10.72,10.72,161,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.04,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.05,448,,facility
DRUG TEST PRSMV CHEM ANLYZR,80307,CPT,301,RC,,,,outpatient,,,41,4.1,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,55.27,55.27,55.27,34,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,62.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,62.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,171.87,131.38,223.26,14,percent of total billed charges,,,33.6,,206.45,131.38,223.26,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,131.38,102.04,131.38,13,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,62.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,129.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,65.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,55.27,55.27,55.27,332,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,62.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,65.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,125.7,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,63.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,62.14,448,,facility
MEASUREMENT OF ACTIN (SMOOTH MUSCLE) ANTIBODY,86015,CPT,0300,RC,,,,outpatient,,,44,4.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.18,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.05,448,,facility
HIV-1 QUANT&REVRSE TRNSCRPJ,87536,CPT,306,RC,,,,outpatient,,,604,60.4,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,75.7,75.7,75.7,61,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,115.05,115.05,369.93,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,124.8,124.8,124.8,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,85.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,85.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,87.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,102.96,65.52,102.96,24,percent of total billed charges,,,33.6,,102.96,65.52,331.06,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,65.52,65.52,66.11,15,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,85.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,177.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,90.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,97.5,97.5,97.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,75.7,75.7,75.7,201,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,85.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,90.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,183.86,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,86.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,85.1,448,,facility
QUANTITATIVE ASSAY DRUG,80299,CPT,301,RC,,,,outpatient,,,366,36.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,13,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,174.64,174.64,174.64,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,171.6,171.6,171.6,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,374.52,374.52,374.52,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.62,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.64,448,,facility
NFCT AGT GNTYP ALYS HIV1 REV,87901,CPT,306,RC,,,,outpatient,,,390,39,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,295,295,295,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,257.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,257.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,265.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,264,264,264,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,257.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,538.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,272.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,229,229,229,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,257.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,272.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,556.22,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,262.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,257.45,556.22,,facility
ASSAY OF ALUMINUM,82108,CPT,301,RC,,,,outpatient,,,45.9,4.59,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,22.66,22.66,22.66,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,25.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,26.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,25.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,53.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,27.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,25.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,27.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,55.06,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,25.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,25.48,448,,facility
ORGANIC ACID SINGLE QUANT,83921,CPT,301,RC,,,,outpatient,,,37.25,3.73,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,18.87,18.87,18.87,11,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,60.72,38.64,203.28,1 through 10,percent of total billed charges,,,33.6,,129.36,129.36,129.36,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,38.64,38.64,38.9,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,21.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,44.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,57.38,57.38,57.38,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,18.87,18.87,18.87,21,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,21.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,37.12,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,21.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,21.21,448,,facility
ASSAY OF ANDROSTENEDIONE,82157,CPT,301,RC,,,,outpatient,,,63.8,6.38,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,26.04,26.04,26.04,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,29.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,30.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,29.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,61.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,31.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,26.04,0.22,26.04,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,29.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,31.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,63.25,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,29.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,29.28,448,,facility
QUANTITATIVE ASSAY DRUG,80299,CPT,301,RC,,,,outpatient,,,106.5,10.65,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,13,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,174.64,174.64,174.64,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,171.6,171.6,171.6,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,374.52,374.52,374.52,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.62,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.64,448,,facility
ASSAY OF G6PD ENZYME,82955,CPT,301,RC,,,,outpatient,,,63,6.3,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,9.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,9.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,20.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,9.7,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.95,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,9.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,9.7,448,,facility
ACETYLCHOLINESTERASE ASSAY,82013,CPT,301,RC,,,,outpatient,,,267,26.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,25.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.03,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.13,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.29,448,,facility
HEMATOCRIT,85014,CPT,305,RC,,,,outpatient,,,5,0.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,2.11,2.11,2.11,26,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,12.16,12.16,78.72,14,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,3.32,3.32,11.21,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,68.24,41.33,70.23,31,percent of total billed charges,,,33.6,,10.03,10.03,41.33,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,41.33,6.38,41.7,26,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,4.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,61.5,9.5,61.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,2.11,2.11,2.11,164,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.13,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,2.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,2.37,448,,facility
ASSAY OF CRYOFIBRINOGEN,82585,CPT,301,RC,,,,outpatient,,,15,1.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,29.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.58,12.58,12.58,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.99,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,24.75,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.14,448,,facility
QUANTITATIVE ASSAY DRUG,80299,CPT,301,RC,,,,outpatient,,,68,6.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,13,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,174.64,174.64,174.64,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,19.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,171.6,171.6,171.6,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,374.52,374.52,374.52,1 through 10,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,38.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16.58,16.58,16.58,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,18.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,19.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,32.62,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,19.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,18.64,448,,facility
ASSAY OF OXALATE,83945,CPT,301,RC,,,,outpatient,,,187.35,18.74,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,14.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,30.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,15.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12.85,12.85,12.85,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,15.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.81,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,14.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,14.45,448,,facility
ASSAY OF BLOOD LIPOPROTEIN,83721,CPT,301,RC,,,,outpatient,,,6,0.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9.34,9.34,9.34,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,29.5,29.5,29.5,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.82,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,21.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9.34,9.34,9.34,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.62,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,10.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,10.5,448,,facility
DRUG SCREEN QUAN LAMOTRIGINE,80175,CPT,301,RC,,,,outpatient,,,16.56,1.66,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.79,11.79,11.79,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,31.15,31.15,57.67,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,14.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,29.5,29.5,29.5,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,11.79,11.79,11.79,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,14.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.63,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.25,448,,facility
HDR RDNCL NTRSTL/ICAV BRCHTX,77771,CPT,342,RC,,,,outpatient,,,853.91,85.39,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,666.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,666.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,686.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,666.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1393.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,706.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,666.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,706.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1945,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,679.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1945,,facility
ALLG SPEC IGE CRUDE XTRC EA,86003,CPT,302,RC,,,,outpatient,,,6.53,0.65,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.64,4.64,4.64,14,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,77.88,77.88,77.88,12,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,5.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,110.88,18.14,178.46,68,percent of total billed charges,,,33.6,,110.88,110.88,110.88,30,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,110.88,44.35,161.62,185,percent of total billed charges,,,34.6,,125.73,125.73,125.73,30,percent of total billed charges,,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,10.91,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,5.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,4.64,4.64,4.64,26,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,5.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.27,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,5.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,5.22,448,,facility
SARS-COV-2 COVID-19 ANTIBODY,86769,CPT,302,RC,,,,outpatient,,,52.66,5.27,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,42.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,43.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,42.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,88.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,44.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,42.13,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,44.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,73.73,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,42.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,42.13,448,,facility
LISTERIA MONOCYTOGENES,86723,CPT,302,RC,,,,outpatient,,,16.49,1.65,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.59,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,27.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.98,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,28.49,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,13.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,13.19,448,,facility
REPAIR TONGUE LACERATION,41250,CPT,761,RC,,,,outpatient,,,474.54,47.45,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,427.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,427.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,440.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,427.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,893.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,453.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,427.54,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,453.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,436.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,427.54,1311,,facility
RADIOTHERAPY DOSE PLAN IMRT,77301,CPT,333,RC,,,,outpatient,,,1650.26,165.03,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,7902.72,6634.88,7902.72,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,7285.32,7285.32,7285.32,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1324.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1324.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1364.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,5473.78,4148.93,6519.74,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,4148.93,4148.93,4148.93,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1324.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,2768.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1404.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,6174,5183.5,6174,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,1155.99,1155.99,1155.99,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1324.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1404.17,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,48815,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1351.18,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,48815,,facility
NEEDLE EMG 3 EXTREMITIES,95863,CPT,922,RC,,,,outpatient,,,186.04,18.6,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,123.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,123.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,126.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,123.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,257.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,130.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,123.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,130.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,478,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,125.6,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,123.14,478,,facility
DRG XTRNL EAR ABSC/HEM COMP,69005,CPT,761,RC,,,,outpatient,,,1930.94,193.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1628.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3303.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1675.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1675.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,1612.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3303.62,,facility
DRAINAGE OF FINGER ABSCESS,26011,CPT,761,RC,,,,outpatient,,,1930.94,193.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1628.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3303.62,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1675.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1580.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1675.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,1612.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3303.62,,facility
C DIFF AMPLIFIED PROBE,87493,CPT,306,RC,,,,outpatient,,,46.59,4.66,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,350.46,350.46,350.46,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,37.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,37.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,38.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,554.36,554.36,554.36,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,199.58,199.58,199.58,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,77.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,39.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,39.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,75.83,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,38.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,37.27,448,,facility
CLTX HUMRL CNDYLR FX W/MNPJ,24577,CPT,761,RC,,,,outpatient,,,1914.16,191.42,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1585.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3216.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1631.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1631.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,1569.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3216.38,,facility
HBB GENE COM VARIANTS,81361,CPT,310,RC,,,,outpatient,,,218.51,21.85,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,174.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,174.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,180.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,174.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,365.35,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,185.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,174.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,185.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,305.92,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,178.31,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,174.81,448,,facility
CLTX RDL&ULN SHFT FX WO MNPJ,25560,CPT,450,RC,,,,outpatient,,,280.86,28.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,243.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,493.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,240.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,236.08,1173,,facility
VASC EMBOLIZE/OCCLUDE BLEED,37244,CPT,361,RC,,,,outpatient,,,13102.26,1310.23,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,16611.38,16611.38,16611.38,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,1027,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1519,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 6500.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,11048.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11048.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11379.9,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11048.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,23091.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11711.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11048.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11711.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,33508,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,11269.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,33508,,facility
ORGANIC ACIDS QUAL EACH,83919,CPT,301,RC,,,,outpatient,,,20.56,2.06,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,14.63,14.63,14.63,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,34.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,14.63,14.63,14.63,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.54,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,16.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,16.45,448,,facility
PDGFRA GENE,81314,CPT,310,RC,,,,outpatient,,,411.89,41.19,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,329.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,329.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,339.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,329.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,688.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,349.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,329.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,349.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,576.64,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,336.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,329.51,688.68,,facility
INJECTION TREATMENT OF NERVE,64680,CPT,360,RC,,,,outpatient,,,1085.56,108.56,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,846.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,846.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,871.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,846.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1769.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,897.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,846.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,897.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2712,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,863.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,2712,,facility
MRSPLZATN BRTHLNS GLND CST,56440,CPT,450,RC,,,,outpatient,,,3723.46,372.35,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3098.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3098.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3191.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3098.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,6475.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3284,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3098.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3284,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3160.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,6475.05,,facility
ELECTROLYTE PANEL,80051,CPT,301,RC,,,,outpatient,,,8.76,0.88,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,6.24,6.24,6.24,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,154.46,116.62,226.12,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,133.06,133.06,133.06,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,7.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,14.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,7.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,6.24,6.24,6.24,15,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,7.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,7.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,15.16,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,7.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,7.01,448,,facility
THAW PRESERVED STEM CELLS,38208,CPT,815,RC,,,,inpatient,,,517.01,51.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,73,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Short Stay Lesser of + Days Threshold 1.00 + Stoploss First Dollar + Reimbursement Rate 57.00 + Basic Per Diem + Fixed Rate 5000.00 + Fixed Amount 157464.00,,,,0,other,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,Short Stay Lesser of + Days Threshold 1.00 + Stoploss First Dollar + Reimbursement Rate 72.00 + Basic Per Diem + Fixed Rate 10000.00 + Fixed Amount 56687.00,,,,0,other,NTE Percentage + Reimbursement Rate 85.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,47.3,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable,,,,0,other,Service item reimbursed under IPPS via MS-DRG; separate payment not applicable + No services performed during 15-month lookback period,,,,facility
REPLANTATION DIGIT COMPLETE,20822,CPT,450,RC,,,,outpatient,,,1914.16,191.42,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1585.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3216.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1631.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1631.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1569.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3216.38,,facility
ASSAY OF CORTICOSTERONE,82528,CPT,301,RC,,,,outpatient,,,28.15,2.82,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,22.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,23.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,22.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,47.07,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,23.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,22.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,23.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,48.65,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,22.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,22.52,448,,facility
BRCA1 GENE KNOWN FAMIL VRNT,81215,CPT,310,RC,,,,outpatient,,,469.06,46.91,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,375.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,375.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,386.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,375.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,784.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,397.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,375.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,397.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,656.69,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,382.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,375.25,784.27,,facility
CLTX CLAVICULAR FX W/MNPJ,23505,CPT,761,RC,,,,outpatient,,,1914.16,191.42,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1585.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3216.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1631.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1538.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1631.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,1569.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3216.38,,facility
ASSAY OF CHLORAMPHENICOL,82415,CPT,301,RC,,,,outpatient,,,15.84,1.58,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,12.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,13.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,12.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,26.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,13.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,12.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,13.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,27.37,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,12.92,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,12.67,448,,facility
PM DEVICE PROGR EVAL DUAL,93280,CPT,480,RC,,,,outpatient,,,44.91,4.49,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,32.72,32.72,35.71,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,35.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,35.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.78,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,112.99,72.55,112.99,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,71.9,71.9,71.9,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,35.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,74.63,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,37.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,33.44,33.44,33.44,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,35.71,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,37.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1463,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,36.42,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,35.71,1463,,facility
MYELOGRAPHY LUMBAR INJECTION,62303,CPT,361,RC,,,,outpatient,,,953.6,95.36,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,750.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,750.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,772.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,750.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1568.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,795.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,750.26,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,795.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2712,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,765.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,2712,,facility
INJ PEMBROLIZUMAB,J9271,HCPCS,636,RC,,,,outpatient,,,70.82,7.08,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,28800,28800,28800,1000,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,60.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,60.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,62.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,23760,23760,23760,4800,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,15255,15255,15255,400,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,60.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,126.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,64.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,60.65,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,64.29,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,123.84,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,61.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,60.65,448,,facility
BIOPSY OF THROAT,42800,CPT,510,RC,,,,outpatient,,,1816.31,181.63,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1484.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1484.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1529.51,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1484.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3103.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1574.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1484.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1574.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,1514.66,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3103.57,,facility
PERQ CERVICOTHORACIC INJECT,22510,CPT,320,RC,,,,outpatient,,,3855.04,385.5,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1268,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1793,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3131.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3131.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3225.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3131.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,6544.81,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,3319.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3131.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,3319.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,3194.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,443,6544.81,,facility
X-RAY EXAM SURGICAL SPECIMEN,76098,CPT,320,RC,,,,outpatient,,,657.04,65.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,522.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,522.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,538.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,279.22,279.22,279.22,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,522.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1092.97,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,554.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,522.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,554.33,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,443,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,533.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,443,1092.97,,facility
CONSLTJ COMPRE RVW REC REPRT,88325,CPT,312,RC,,,,outpatient,,,203.43,20.34,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,167.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,340.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,172.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,163.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,172.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,78.23,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,166.32,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,78.23,448,,facility
THER SPI PNXR CSF FLUOR/CT,62329,CPT,361,RC,,,,outpatient,,,823.63,82.36,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,675.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,675.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,695.84,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,675.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1411.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,716.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,675.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,716.1,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2712,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,689.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,2712,,facility
CLEAN OUT MASTOID CAVITY,69220,CPT,761,RC,,,,outpatient,,,238.44,23.84,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,197.77,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,401.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,203.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,192.01,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,203.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,195.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,192.01,448,,facility
ASSAY OF PORPHOBILINOGEN,84110,CPT,301,RC,,,,outpatient,,,10.55,1.06,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,8.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,30.1,30.1,30.1,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,17.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,8.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.44,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,8.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,18.24,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,8.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,8.44,448,,facility
UNLISTED PX BILIARY TRACT,47999,CPT,750,RC,,,,outpatient,,,1079.61,107.96,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,868.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,868.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,894.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,868.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1814.2,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,920.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,868.04,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,920.12,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3821,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,885.4,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3821,,facility
NFCT DS FUNGI DNA 15 TRGT,0140U,CPT,300,RC,,,,outpatient,,,195.94,19.59,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,156.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,156.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,161.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,156.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,327.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,166.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,156.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,166.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,274.31,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,159.88,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,156.75,448,,facility
THER RAD SIMULAJ FIELD SMPL,77280,CPT,333,RC,,,,outpatient,,,161.6,16.16,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,1167.36,1167.36,1167.36,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,128.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,128.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,132.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,612.86,612.86,612.86,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,612.86,612.86,618.34,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,128.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,268.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,136.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,912,912,912,1 through 10,percent of total billed charges,,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,128.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,136.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,48815,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,131.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,128.64,48815,,facility
PLACE CECOSTOMY TUBE PERC,49442,CPT,361,RC,,,,outpatient,,,1405.45,140.55,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1179.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,2393.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1213.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1213.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3821,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1168.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3821,,facility
CYTOPATH EVAL FNA REPORT,88173,CPT,311,RC,,,,outpatient,,,64.54,6.45,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,243.84,28,243.84,1 through 10,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,49.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,49.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,51.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,201.17,128.02,402.34,1 through 10,percent of total billed charges,,,33.6,,128.02,128.02,128.02,1 through 10,percent of total billed charges,,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,128.02,44,129.16,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,49.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,104.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,52.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,84.1,84.1,84.1,21,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,49.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,52.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,78.23,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,50.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,49.87,448,,facility
NERVE TEASING PREPARATIONS,88362,CPT,310,RC,,,,outpatient,,,1024.11,102.41,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,771.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,771.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,794.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,771.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1611.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,817.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,771.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,817.34,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,946.68,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,786.5,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1611.56,,facility
REPOSITION VENOUS CATHETER,36597,CPT,761,RC,,,,outpatient,,,1907.41,190.74,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1506.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1506.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1551.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1506.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3148.69,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1596.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1506.55,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1596.94,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,1536.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3148.69,,facility
INTMD RPR FACE/MM >30.0 CM,12057,CPT,361,RC,,,,outpatient,,,474.9,47.49,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,400.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,813.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,412.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,412.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2440,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,396.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,389.05,2440,,facility
COLONOSCOPY W/ABLATION,45388,CPT,750,RC,,,,outpatient,,,1405.45,140.55,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1179.61,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,2393.57,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1213.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1145.25,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1213.96,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,3821,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1168.15,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3821,,facility
COLPOSCOPY VULVA W/BIOPSY,56821,CPT,761,RC,,,,outpatient,,,382.08,38.21,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,291.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,291.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,300.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,291.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,609.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,309.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,291.64,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,309.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,297.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,291.64,1173,,facility
ASSAY OF ANGIOTENSIN II,82163,CPT,301,RC,,,,outpatient,,,25.65,2.57,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,20.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,21.14,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,20.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,42.89,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,21.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,20.52,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,21.75,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,44.35,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,20.93,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,20.52,448,,facility
TREAT HIP DISLOCATION,27250,CPT,761,RC,,,,outpatient,,,280.86,28.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,243.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,493.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,240.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,236.08,1173,,facility
BIOPSY OF LIP,40490,CPT,761,RC,,,,outpatient,,,290.91,29.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,226.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,226.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,233.48,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,226.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,473.76,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,240.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,226.68,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,240.28,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,231.21,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,226.68,473.76,,facility
EXC TR-EXT MAL+MARG 3.1-4 CM,11604,CPT,761,RC,,,,outpatient,,,837.95,83.8,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,677.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,677.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,698.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,677.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,1416.43,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,718.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,677.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,718.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,691.27,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,1416.43,,facility
NSL/SINS NDSC SURG BX POLYPC,31237,CPT,450,RC,,,,outpatient,,,2021.43,202.14,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,898,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1311,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1703.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1703.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1754.56,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1703.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,3560.23,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,1805.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1703.46,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,1805.67,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,1737.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,3560.23,,facility
ZIKA VIRUS IGM ANTIBODY,86794,CPT,302,RC,,,,outpatient,,,21.06,2.11,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17.36,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,35.22,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16.85,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,36.4,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17.19,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,16.85,448,,facility
DESTRUCTION PENIS LESION(S),54050,CPT,761,RC,,,,outpatient,,,474.9,47.49,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,400.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,813.11,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,412.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,389.05,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,412.39,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,56.6,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,396.83,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,389.05,813.11,,facility
CLTX DSTL RAD/ULN DISLC MNPJ,25675,CPT,450,RC,,,,outpatient,,,280.86,28.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,243.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,493.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,240.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,236.08,1173,,facility
CLTX HUMRL CNDYLR FX WO MNPJ,24576,CPT,450,RC,,,,outpatient,,,280.86,28.09,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,243.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,57.1,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,493.41,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,236.08,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,250.24,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,240.8,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,236.08,1173,,facility
ASSAY OF CERULOPLASMIN,82390,CPT,301,RC,,,,outpatient,,,13.43,1.34,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9.55,9.55,9.55,17,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.06,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,21.65,21.65,21.65,1 through 10,percent of total billed charges,,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,13.78,13.78,13.9,1 through 10,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,10.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,22.45,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,11.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,9.55,9.55,9.55,44,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,10.74,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,11.38,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,23.21,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,10.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,10.74,448,,facility
INJ. PEMETREXED NOS 10MG,J9305,HCPCS,636,RC,,,,outpatient,,,7.02,0.7,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,64,,17930.88,17930.88,17930.88,198,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,59,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,53,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,67,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,6.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,6.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,7.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,52.8,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,3837.48,3741.54,4796.85,179,percent of total billed charges,,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,6.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,14.53,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,7.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,6.95,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,7.37,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,11.33,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,7.09,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,6.95,448,,facility
ABLATE BONE TUMOR(S) PERQ,20982,CPT,361,RC,,,,outpatient,,,15674.78,1567.48,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,12260.62,12260.62,12260.62,1 through 10,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 6500.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,NTE Dollar Amount + Fixed Amount 10000.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,16780.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,16780.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,17284.3,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,16780.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,35072.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,17787.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,16780.87,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,17787.72,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,80,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,82,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,10550,,,,,,,fee schedule,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,17116.49,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 102.00,448,35072.02,,facility
SIGMOIDOSCOPY W/RESECTION,45349,CPT,750,RC,,,,outpatient,,,3344.05,334.41,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,669,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,1173,,,,,,,fee schedule,NTE Dollar Amount + Fixed Amount 50.00 + Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,90,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + No services performed during 15-month lookback period,448,,,,,,,case rate,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,54,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 6500.00 + No services performed during 15-month lookback period,,68,,,,,0,percent of total billed charges,Lesser of + Percentage of total billed charges + Reimbursement Rate 100.00 + Calculated Reimbursement + NTE Dollar Amount + Fixed Amount 10000.00 + No services performed during 15-month lookback period,2656.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2656.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,2736.16,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 103.00,,44.9,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,58.2,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,33.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,34.6,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,45,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2656.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,5552.02,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 209.00,,42.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,2815.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,50,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,71,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,21,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,40,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,35.5,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,58,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,70,,,,,0,percent of total billed charges,No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2656.47,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 100.00,,,,,,,0,,Not paid by the payer plan + No services performed during 15-month lookback period,,,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00,,,,0,other,Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 + No services performed during 15-month lookback period,2815.86,,,,,,,other,Percent of Medicare Reimbursement + Reimbursement Rate 106.00,,,,